老年心脏瓣膜置换术85例报告

Cardiac valve replacement in elderly patients(85 cases report)

目的总结老年心脏瓣膜置换术的经验。方法对我院1999年1月至2004年7月间60岁以上85例心脏瓣膜病手术患者进行了回顾性总结。风湿性心脏瓣膜病59例,黏液样病变11例,老年退行性瓣膜钙化病变7例,冠心病致二尖瓣关闭不全2例,动脉瘤致主动脉瓣关闭不全4例,先天性心脏病室缺伴主动脉瓣关闭不全1例。结果单瓣置换术61例(其中MVR39例,AVR21例,TVR1例)。双瓣置换术14例,CABG+MVR2例,CABG+AVR4例,Bentall术4例。手术死亡3例(死亡率3.5%)。手术主要并发症是呼吸功能不全13例,肺部感染9例,心律失常25例,心包积液4例,术后肾功能损害5例,低心排4例。结论只要严格手术指征,加强围术期管理,老年心脏瓣膜置换术可取得良好效果。

Objective This study is to access the short term result of cardiac valve replacement in old patients. Methods Between January 1999 and July 2004,there were 85 cases of old aged patients with valve disease,whose mean ages were 60- 80 （65±5） .The main pathology cause of valve diseases were rheumatic and degenerative .Mechanical or/and biosynthesis artificial valve were implanted with standard surgical procedure and standard cardiopulmonary bypass technique includes moderate systemic hypothermia and myoeardiac protection with cool blood cardioplegla perfusion. The perio-operative management different from common adult patients were can-ied out in all patients. Results The 30 days operative mortality was 3.5%（ 3 death）,the late death were 2 cases. The main postoperative complications were cardiac arrhythmia （25 cases）, respiratory dysfunction（ 13 cases）, pneumonia（ 9 cases）, renal dysfunction（ 5 cases）and low cardiac output syndromes （ 4cases ）. The heart function of all discharged patients were improved by follow-up 3 months to 1 year. Conclusion With proper patient selection and advanced perio-operative management, the short term outcome of cardiac valve replacement in old aged patients was satisfied .