2349例心脏瓣膜置换术早期死亡原因分析

Early death causes in 2349 patients who receiving heart valve replacement

目的分析2349例心脏瓣膜置换术病人的死亡原因，以期进一步提高治疗水平。方法1995年1月至2007年12月，2349例心脏瓣膜病病人接受人工心脏瓣膜置换手术。其中二尖瓣置换术（MVR）1333例，主动脉瓣置换术（AVR）271例，二尖瓣、主动脉瓣同期置换术（DVR）736例，三尖瓣置换术（TVR）9例。结果早期病死率1995年至1999年6．81％，2000年至2004年3．22％，2005年至2007年2．82％。全组总早期病死率3．40％。结论心脏瓣膜置换术早期死亡的原因主要是低心排血量综合秆、肾功能奇竭、心德失常、肺部戚染、腩向管膏外车富砖裂和名器官秦缔功能寄竭笺．

Objective The early causes of death were analyze in 2349 patients who had undergone heart valve replacement. Methods Methods From January 1995 to December 2007, 2349 patients with heart valve diseases received heart valve replacement. 1109 cases were male and 1240 were female. The mean age of the patients was （41± 19） years old. 1962 cases had rheumatic heart valve disease, 308 had congenital heart valve disease, 39 had infective endocarditis, 29 underwent reintervention by heart valve replacement, 11 had Marfan syndrome. 34 cases with coronary heart disease underwent heart valve prosthesis implantation and coronary artery bypass grafting. Mitral valve replacement（MVR） was performed in 1333 patients, aortic valve replacement （AVR） in 271, double valves replacement （DVR） in 736 and tricuspid valve replacement （TVR） in 9. There were 3075 mechanical valves and 10 bioprosthetic valves. Results From 1995 to 1999, death occurred in 16 of the 235 cases, early mortality rate was 6.81%. From 2000 to 2004, death occurred in 35 of the 1087 cases, early mortality rate was 3.22%. From 2005 to 2007, there were 29 deaths among 1027 cases, with an early mortality rate of 2.82%. Overall early mortality rate was 3.40%. The early mortality rate was 2.32% （31 in 1333 cases） in patients who underwent MVR, 3.32% （9 in 271 ） in patients who underwent AVR, 5.24% （ 40 in 736） in patients who underwent DVR, 5.50% （7 in 127） with LVEDD ≥70 mm, 4.60% （ 14 in 304） with LVEF 〈 0.40, 2.14% （9 in 419） with NYHA class II ,2.42% （37 in 1529） with NYHA class Ⅲ, and 8.48% （34 in 401 ）with NYHA class IV. The causes of 80 deaths were low cardiac output syndrome in 31 cases （38.8%） , renal failure in 14 cases（ 17.5% ） ,arrhythmia in 10 cases（ 12.5% ） , pulmonary infections in 8 cases （ 10.0% ）. cerebrovascular accident in 5 （ 6.3% ）, left ventricular rupture in 5 （ 6.3% ）, muhisystem and organ failure in 5 （ 6.3% ） , and other cause in 2 cases （2.5%）. Conclusion The causes of early death after heart valve replacement axe low cardiac output syndrome, renal failure, arrhythmia, pulmonary infection, eerebrovascular accident, left ventricular rupture and muhisystem and organ failure.