心脏瓣膜置换后再次瓣膜手术的临床分析

Clinical analysis of valve reoperative cases after valve replacement

目的分析心脏瓣膜置换术后再次瓣膜手术的原因,探讨手术方法及对结果的影响因素。方法对1986年1月～2006年6月瓣膜置换后行再次瓣膜手术的病例进行回顾性研究,用同期同类病例做对照进行分析。结果共52例再次手术中,生物瓣衰败18例,继发其他瓣膜病变13例,瓣周漏6例,非机械性瓣膜功能障碍10例,机械性功能障碍2例,心内膜炎伴赘生物形成3例;手术方式:单独行二尖瓣置换术(MVR)15倒,主动脉瓣置换(AVR)12例,二尖瓣置换加主动脉瓣置换术(DVR)14例,瓣膜修复7例,同期三尖瓣成形术(TVP)共40例,三尖瓣置换术(TVR)1例;手术难度明显大于首次手术,并发症增多,围术期死亡率5.77%。结论注意术前心功能的改善,术中体外循环尽早建立,完善术中心肌保护、手术技巧的掌握,术后积极纠正低心排出量综合征(低心排)、防止并发症的发生是减少手术死亡的关键因素。

Objective Summarize the results of valve reoperative cases after valve replacement, and try to find influencing factors of the operation efficiency. Methods 52 valve reoperative cases,from January 1986 to June 2006,were retrospective studied and compared with the results of the first valve operations. Results The 52 cases included bioprosthetic failure （n= 18）, other valve failure （n= 13）, perivalvular leakage （n=6）, non-mechanical valve insufficiency （n= 10）, mechanical valve insufficiency（n= 2）, endocarditis and vegetation（n= 3）; Operations include mitral valve replacement （MVR）（n = 15）, aortic valve replacement（AVR） （n= 12）, MVR＋AVR（DVR）（n= 14）, mitral or aortic valve repair（n= 7）. There are total 40 patients were performed tricuspid valve plasty in these cases;tricuspid valve replacement （TVR）（n= 1）. The operation was more difficulty for performance than the first. There were more complications with the second operation than the first. Perioperative mortality rate was 5.77%. Conclusion The key factors to reduce the death of reoperation are improving preoperative heart function, setting up extracorporeal circulation as soon as possible,consummating myocardial preservation, perfect operate technics,correcting low cardiac output sydrom in time and preventing complications.