人工心脏瓣膜置换术297例分析

Aanalysis of 297 cases of heart valve prosthesis replacement

目的总结我院2001年1月至2007年1月297例心脏瓣膜置换手术临床经验。方法手术在全麻体外循环中度低温下进行,全组共297例,其中行二尖瓣置换术(MVR)152例、主动脉瓣置换术(AVR)46例(其中主动脉根部拓宽主动脉瓣置换8例)、双瓣膜置换术(DVR)97例、三尖瓣置换术(TVR)2例。合并三尖瓣关闭不全(TR)者行DeVega或Kay成形术,术中同期行冠状动脉搭桥4例、行射频消融Maze手术治疗房颤1例。结果早期死亡10例,死亡率3.4%,其中MVR、AVR、DVR的死亡率分别为2.6%、6.5%和3.1%。结论瓣膜置换术是治疗心脏瓣膜病变的可靠、有效手段。加强围术期处理,选择恰当的手术时机,缩短手术时间,加强心肌保护,提高手术技巧,保留二尖瓣下结构,积极处理三尖瓣反流。主动脉瓣置换时,尽可能置入大一号的瓣膜,减少跨瓣压差,以利术后左室重构,可提高远期疗效,减少术后并发症、降低死亡率,对重症瓣膜病患者尤为重要。

Objective To improve the operative effect and decrease mortality, 297 cases of heart valve prosthesis replacement between January 2001 and January 2007 in our hospital were reviewed. Methods All 297 cases were performed under moderate hypothermia cardiopulmonary bypass and general anesthesia.152 cases were performed with mitral valve replacement, 46 cases aortic valve replacement （including 8 cases combined with enlargement of aortic root）, 97 cases double valves replacement, 2 cases tricuspid valve replacement. DeVega or Kay valvoplasty were performed if combined with tricuspid valve incompetence.CABG were performed at the same time in 4 cases.Radiofrequency ablation Maze were performed to treat atrial fibrillation at the same time in 1 case. Results 10 cases early death （3.4% mortality）, including mortality of MVR,AVR and DVR was 2.6%,6.5% and 3.1% relatively. Conclusion Valve prosthesis replacement is reliably and effective to treat heart valve diseases. Strengthening perioperative treatment,choosing correctly surgical occasion, shortening surgical time, strengthening myocardial protection, improving surgical technique, maintain supvalve construction, deal with tricuspid incompetence actively, implanting larger valve prosthesis to decrease transvalve pressure gradient when aortic valve prosthesis replacement and benefit left ventricular reconstruction postoperatively will improve long term effect,decrease complication and mortality, especially more important to serious valve patients.