心脏瓣膜置换术后再次瓣膜置换25例临床分析

Clinical analysis of reoperation with prosthetic valve replacement: Report of 25 cases

目的探讨人工心脏瓣膜再次置换的原因及效果。方法回顾分析25例人工心脏瓣膜置换术后再次接受瓣膜置换手术病人的临床资料;初次换瓣到再次换瓣时间为0.5～15(10.5±1.5)年;手术均在体外循环下进行,其中心脏停跳10例,心脏不停跳15例;置换的瓣膜有二尖瓣13例,主动脉瓣10例,三尖瓣2例。结果主动脉阻断时间为55～158(89±34)min;体外循环时间为80～204(112±32)min;无一例住院死亡,住院天数15～30(20.5±2.5)d;出院时心功能改善至Ⅰ级16例,Ⅱ级9例。结论再次换瓣手术应恰当掌握手术时机,可应用传统的心脏停跳法及不停跳法,手术疗效确切,可有效改善患者的预后。

Objective To study the effect of the reoperation with prosthetic valve replacement. Methods Between January 2002 and January 2011, the clinical data of 25 patients undergoing cardiac valve replacement again were retrospectively analyzed. The interval between two procedures was 0. 5 to 15 years average 9 （10. 5 ±1.5）years. All operations were performed in cardiopulmonary bypass（CPB）. Of them, 10 patients underwent arrested heart operation, and 15 patients underwent beating heart operations. The heart valve replacement included MVR in 13 patients, AVR in 10 patients,TVR in 2 patients. Results The aortic clamping time was 55 - 158（89 ±34）rain;The average CPB time was 80 - 204 （112 ±32）min, no patient died in the admission period and the hospitalized time were 15 - 30 d [ average （ 20. 5 ±2. 5 ） d ]. The cardiac function of all surviving patients was improved, including NYHA class I in 16 patients and class Ⅱin 9 patients. Conclusion Proper timing in reoperation with prosthetic valve replacement should be chosen, and traditional prosthetic valve replacement by open heart surgery with arrested heart and beating heart can be used. The surgery is proved valuable and can improve the prognosis of the patients.