心脏不停跳瓣膜置换术161例临床分析

A clinical analysis of on-pump beating heart valve replacements in 161 cases

目的总结浅低温心肺转流(CPB)心脏不停跳瓣膜置换术161例治疗经验。方法手术种类:二尖瓣置换81例,主动脉瓣置换34例,主动脉瓣及二尖瓣置换40例,三尖瓣置换6例。换瓣同时行三尖瓣成形50例,心房纤颤消融35例,左房血栓清除9例,房间隔缺损或室间隔缺损修补8例,冠状动脉旁路移植4例,巨大左心房折叠19例,保留二尖瓣后瓣及瓣下结构95例,二尖瓣全瓣保留6例,主动脉根部加宽换瓣3例。结果术后早期死亡5例(3.10%)。156例痊愈出院,无一例气栓发生。结论浅低温CPB下心脏不停跳行瓣膜置换技术对多数心脏瓣膜置换术患者是适用的。

Objective To summarize the experiences of 161 patients underwent on-pump beating heart valve replacements. Methods The surgeries performed were mitral valve replacements in 81 cases, aortic valve replacements in 34 cases, double valve replacements in 40 cases, tricuspid valve replacement in 6 cases, valve replacement and tricuspid valvoplasty simultaneously in 50 cases. The following procedures were carried out at the same time, which included atrial fibrillation ablation in 35 cases,left atrial thrombus removal in 9 cases, atrial septal defect or ventricular septal defect repair in 8 cases, coronary artery bypass grafting in 4 cases, left atrium plication in 19 cases, retention of mitral valve anterior leaflet and subvalvular structure in 95 cases, complete retention of naive leaflets in 6 cases, and aortic root enlargement in 3 cases. Results No air embolism occurred in any case. Early postoperative death occurred in 5 cases （3.10%） and the rest were all cured. Conclusion The technique of on-pump beating heart valve replacements under mild hypothermia is suitable for the majority of patients, in whom heart valve replacement is indicated.