二尖瓣成形术围术期死亡危险因素分析

Risk factors of perioperative mortality after mitral leaflet repair

目的回顾性分析二尖瓣成形术后围术期死亡的危险因素。方法 1985年3月至2006年6月542例病人行二尖瓣成形手术,按手术死亡与否分成两组,进行单因素分析和多因素 logistic 回归分析。结果全组死亡20例(3.7%),单因素显著性分析发现年龄、心衰史、左室收缩末内径、术前左室射血分数(LVEF)、心功能Ⅲ～Ⅳ级、体外循环时间、主动脉阻断时间和成形术同期行冠状动脉旁路移植术与二尖瓣成形术围术期死亡有相关性。多因素 logistic 回归分析结果显示,心衰史、术前左室射血分数和同期行冠状动脉旁路移植术是独立危险因素。结论心衰史、术前左室射血分数和同期行冠状动脉旁路移植术是二尖瓣成形术围术期死亡的独立危险因素。

Objective To analyze the risk factors of perioperative mortality after mitral leaflet repair retrospectively. Methods Data of 542 patients undergoing mitral leaflet repair in An Zhen Hospital between March 1985 and June 2006 were collected. Preoperative and operative variates were evaluated by univariate and multivariate logistic stepwise regression analysis. Results 20 patients （3.7%） died postoperatively within 30 days. Univariate risk factors included age, preoperative congestive heart failure, preoperative left ventricular end-systolic diameter, preoperative left ventricular ejection fraction, NYHA class Ⅲ～Ⅳ, CPB time ,Cross-damp time and mitral leaflet repair concomitant coronary artery bypass graft （CABG）. Logistic stepwise regression analysis showed that preoperative congestive heart failure, preoperative left ventricular ejection fraction and mitral leaflet repair concomitant CABG were inependent risk factors of mortality after mitral leaflet repair. Conclusion Conclusion It suggests that preoperative congestive heart failure, preoperative left ventricular ejection fraction and mitral leaflet repair concomitant CABG are independent risk factors for mortality after mitral leaflet repair.