老年心脏瓣膜置换术

Heart valve replacement in the elderly patient

目的 观察首次和多次心脏手术的老年心脏瓣膜病施行瓣膜置换术的疗效。方法 从 1 994年 8月到 1 998年 8月 ,共对 5 7例老年患者 (6 0～ 75岁 )施行瓣膜置换术 ,包括 1 3例 (2 2 .8% )二尖瓣行“闭式分离术”后再狭窄患者和 6例 (1 0 .5 % )二尖瓣再狭窄行“双径闭式分离术”后再 再狭窄患者。结果 手术死亡 4例 (7.0 1 % ) ,其中有 1例再狭窄和 2例再 再狭窄患者。随访 3个月到 4年 ,晚期死亡 4例 ,3例 (5 .8% )死于顽固性心力衰竭和急性心梗 ;瓣膜相关的并发症有 :3例 (5 .8% )血栓栓塞形成 ,2例 (3.9% )心衰 ,1例 (1 .9% )感染性心内膜炎和 1例 (1 .9% )心肌梗死 ;存活者中有 95 .7%的病人心功能达到 1～ 2级。结论 随着心肌保护水平的提高 ,手术技术和围术期处理的成熟完善 ,老年瓣膜置换术是安全有效的 ;对于第二和第三次手术病例 。

Objective To review over the heart valve replacement in the elderly patients, including those operated secondarily and tertiarily. Methods From August 1994 to August 1998, 57 consecutive elderly cardiac patients (age 60 to 75 years, mean 65.8 years) were operated in our hospital. There were 38 mitral valve replacement, 7 aortic valve replacement and 12 multiple valvular replacement, including 13 (22.8%) re stenotic mitral valve after left route closed mitral commissurotomy and 6 (10.5%) re re stenotic mitral valve after reoperative dual route closed mitral commissurotomy. Results Four patients (7.01%) died, including 1 re stenotic and 2 re re stenotic patients. The follow up period was 3 months to 4 years. There were 4 late deaths, 3(5.8%) related to heart failure and myocardial infarction. Valve replacement related complications were thromboembolism in three (5.8%) cardiac failure, in two (3.9%) infective endocarditis and myocardial infarction in one (1.9%) each. 95.7% of the survived patients were in NYHA function grade 1～2. Conclusions Valvular replacement surgery in the elderly can be performed safely and effectively with improved myocardial protection, intraoperative strategies and postoperative care. And for those re and re re stenotic patients, the details of pulmonary and renal functions should be carefully evaluated preoperatively. (Shanghai Med J, 2000,23∶603 605)