95例再次人工机械瓣置换术

Retrospective analysis in 95 cases patients with reoperative cardiac valve replacement

目的:总结95例再次人工机械瓣置换术的外科治疗经验。方法:自2000年1月至2010年4月共行心脏瓣膜置换术3235例,其中95例行再次人工机械瓣置换术。本组95例第一次手术均是行人工机械瓣置换术后的患者,其中机械瓣功能障碍65例,瓣周漏19例,机械瓣心内膜炎11例,手术均在全麻体外循环心脏停跳下进行,其中急诊手术35例,限期手术20例,择期手术40例。其中二尖瓣置换74例,主动脉瓣置换12例,双瓣置换9例,同期行三尖瓣置换13例,三尖瓣成形45例。结果:围术期死亡7例,病死率7.37%,其中有3例是术中无法脱离体外循环机,2例因术后出现严重低心排出量综合征(低心排)及多脏器功能衰竭死亡,1例死于术后心室颤动(室颤),1例死于术后脑出血、脑疝,其余88例痊愈出院。随访3个月至4年,晚期死亡4例,存活患者心功能均明显改善。结论:掌握好手术时机、手术技术及术后处理,是再次机械瓣置换术成功的重要因素。

Objective：To retrospectively analysis 95 cases of reoperative cardiac valve replacement.Methods：From January 2000 to April 2010,there were total 3 235 cases cardiac valve replacement operations in our hospital,all 95 patients were accepted artificial mechanical valve replacement at the first operations,reasons of reoperation are acute heart valve malfunction for 65 cases,paravalvular leak for 19 cases,endocarditis 11 cases.All the redo procedure were operated under general anesthetic and Cardiopulmonary Bypass（CPB）,35 cases are emergency surgery,20 cases limited selective surgery,40 cases selective surgery.74 patients accepted single mitral valve re-replacement,12 patients accepted single aorta valve re-replacement,rereplacements of both mitral and aorta valves were done in 9 cases,among all cases,tricuspid vale replacement was carried on in 13 cases,tricuspid valve plasty in 45 cases at the same time.Results：There were 7 deaths （mortality 7.37%）,3 cases died from fail of weaning off CPB,2 cases dead from low cardiac-output syndrome,and multiple organ failure,1 case with ventricule fibrillation,1 case with cerebral hemorrhage and hernia.88 survivals were followed 3months to 4 years.There were 4 late deaths.The rest of patients survived with improved heart function.Conclusion：Timing of the surgery;surgical techniques and post-operative care are important for the success of reoperative cardiac valve replacement.