心脏瓣膜置换术后机械瓣功能不全再次手术

目的对心脏瓣膜机械瓣发生功能不全的原因进行分析,讨论再次手术方法的选择。方法选择心脏瓣膜置换术后发生机械瓣膜功能不全的病人16例,对其手术资料及临床资料进行回顾性分析,手术种类包括二尖瓣置换术及主动脉瓣置换术,均为择期手术,对其发生功能不全的原因及再次手术方法进行汇总分析,并统计不同方法的救治成功率。结果本组患者再次手术的原因均为瓣环组织增生和血栓形成,其中包括机械瓣置换术9例,生物瓣置换术7例,机械瓣组死亡4例(44.44%),生物瓣组死亡1例(14.28%),两组比较差异具有显著性意义。结论对于瓣环组织增生和血栓形成引起的术后机械瓣功能不全,应用生物瓣进行再次手术的成功率较高。

Objective To analyze the reasons resulting in dysfunction of mechanical valve and discuss the principles for selection of method of re-operation. Methods 16 patients with dysfunction of mechanical valve after cardiac valve replacement （CVR） were selected and their clinical data were reviewed. Methods CVR included mitral valve replacement and aortic valve replacement and all patients underwent selective operations. The reasons resulting in dysfunction of mechanical valves and methods of re-operations were comprehensively analyzed and recovery rates of different methods of re-operation were accounted. Results The reason resulting in re-operation in this study was hyperplasia of valve ring and thrombosis, and methods of re-operation included mechanical valve replacement （9 cases） and bioprosthetic valve replacement （7 cases）. The mortality in the group receiving mechanical valve replacement was 44.44% （4/9） and that in the group receiving bioprosthetic valve replacement was 14.28% （1/7）. There was statistical difference between the two groups. Conclusion The successful rate of re-operation with bioprosthetic valve is higher than that of re-operatiun with mechanical valve in patients with dysfunction of mechanical valve after CVR, which results from hyperplasia of valve ring and thrombosis.