心脏瓣膜直视手术后再次瓣膜手术155例分析

Reoperative valve surgery after open-heart valve surgery:a report of 155 cases

目的：总结直视下瓣膜成形术或人工瓣膜置换术后再次行瓣膜手术的临床资料和外科经验。方法：收集1996年1月至2010年10月的155例瓣膜直视手术后再次行瓣膜手术患者,包括各种瓣膜的再次单瓣置换术,双瓣置换术和三尖瓣成形术,以及瓣周漏修补术等。再次手术间隔1~266（94.82±85.37）月。手术均在中低温体外循环下,采用灌注冷晶体或含血停搏液下完成。结果：再次瓣膜手术住院死亡率为5.81%,其中2005年至2010年的住院死亡率为2.75%。再次手术后左室舒张末期容积,房室内径显著缩小。术后最常见的并发症为室性心律失常和低心排。结论：掌握再次瓣膜手术特殊的临床特点,采取针对性的诊疗策略,可以提高再次瓣膜手术的成功率。

Objective To summarize the characteristics of reoperative valve surgery after previous open-heart valve surgery.Methods From 1996 to 2010,155 patients who underwent reoperative valve surgery,either valve replacement or tricuspid annuloplasty or the repair of perivalvular leakage were included in the study.The reoperative interval was 1-266（94.82±85.37） months.All surgeries were carried out with extracorporeal circulation under moderated hypothermia.The cardioplegic solution in cold crystal or blood was used if heart beating was stopped during the surgery.Results The total in-hospital mortality was 5.81%,while it was 2.75% from 2005 to 2010.The end-diastolic dimension,size of atrium and ventricles were reduced after the reoperation.Ventricular arrhythmia and low cardiac output were the most frequent complications.Conclusion The success rate of reoperative valve surgery can be improved by the distinctive therapeutic strategies based on the clinical characteristics and therapy principles obtained from practice experiences.