166例生物瓣膜的临床应用结果

Retrospective study of clinic use on result of application of 166 cases with biovalves

目的总结166例异种心脏生物瓣膜的临床应用及远期结果与随访。方法自1987年3月￣2003年5月,用自制心脏生物瓣膜223枚,为166例患者行瓣膜置换术。采用猪主动脉瓣94枚,牛心包瓣129枚;其中163枚采用复合方法鞣制,60枚采用单纯戊二醛方法鞣制。男70例,女96例;年龄12￣62岁平均(42.23±8.12)岁。二尖瓣病变89例,三尖瓣病变39例,主动脉瓣病变10例,多瓣膜病变28例。生物材料选用单纯戊二醛鞣制和三氧化二铬复合鞣制两种方法处理。结果术后早期(30d内)死于低心输出量综合征4例,左心室破裂2例,肾功能衰竭死亡2例。生存者随访,术后5a效果良好,晚期死亡2例,均死于10a后因生物瓣衰败未及时再次换瓣。失访16例。随访10￣15a89例,8￣9a27例,8a以下34例。再次瓣膜置换41例,猪瓣20例,牛心包瓣21例。结论复合方法鞣制异种生物瓣膜的各项理化性能指标已达到《人工心脏瓣膜通用技术条件》GB—12279—90的标准要求,是治疗心脏瓣膜疾病的可靠、有效手段,尤其近年手术结果令人鼓舞。

[Objectives] To sununarize the clinic data and long-term effects of hetemgcnic biovalves of 166 patients. [Methods] From March 1987 to May 2003, 166 patients underwent prosthetics valve replacement procedures with 223 self-made biovalvcs. Ninety-four swine aortic valves and one hundred and twenty-nine bovine pericardial valves were used in these patients. The materials for the hetemgenic biovalves were tannod with 2 methods： 163 biovalves used the compound method with chromium trioxide, and 94 biovalves used the simple method with amylic aldehyde only. These patients including 70 males and 96 females whose ages were from 12 to 62 and average age is （42.23±8.12）. Among these patients, mitral valve disease was in 89 cases, tricuspid valve disease in 39, aortic valve disease in 10 cases and multiple valve disease in 28 cases. [Results] Eight patients died early （in 30 years）. Four died of the heart function failure, two died of the renal-insufficiency, and one died of the breach of left ventricle. A follow-up indicated that the effect was well in 5 years and 2 cases lately died of postoperative blovalves fatigued but not replace valves in time 10 years later. There are 16 cases missed follow-up. Eighty-nine patients underwent a follow-up of 10 to 15 years and 52 patients are alive at present. Among these 89 cases, patients were alive 8 to 9 years and 34 patients were alive under 8 years. Forty-one patients underwent prosthetic valve replacement for second time among which 35 cases wcrc alive more than 10 years, 6 cases were alive 8 to 10 years. There were 20 swine aortic valves and 21 bovine pericardial valves had been used in these 41 patients. [Conclusions] The physical and chemical indicators of the blovalves made of materials compoundly tanned with chromium trioxide show that the biovalves conform with the GB12279-90 standard of The General Technical Terms of the Prosthetic Heart Valves. The compound method to cure heart valve disease, especially that the result of operations in recent years is encouraging.