118例再次瓣膜置换手术的临床分析

Clinical analysis of re-valve replacement surgery in 118 cases

目的 总结118例再次瓣膜置换手术治疗的方法及体会。方法 回顾性分析118例经超声心动图明确诊断需再次行瓣膜置换手术患者的临床资料,其中二尖瓣和主动脉瓣置换12例,主动脉瓣置换31例,二尖瓣置换70例,三尖瓣置换5例。再次瓣膜置换手术原因:机械瓣失功62例,瓣周漏27例,生物瓣衰败26例,生物瓣功能障碍3例。结果 围术期死亡8例,死亡率为6.8%,死亡原因为多器官功能衰竭、恶性心律失常、严重低心排血量综合征。术后发生并发症19例,发生率为16.1%。结论 相对于首次瓣膜手术,再次瓣膜置换手术的操作难度大、出血多,术后并发症发生率及死亡率高。再次瓣膜手术的主要原因为机械瓣失功、瓣周漏及生物瓣衰败等。

Objective To summarize the approaches and experience of1 18 cases of re-valve replacement surgery. Methods The clinical data of1 18 patients requiring re-valve replacement surgery afteRdefinitive diagnosis confirmed by echocardiography were analyzed retrospectively, including1 2 cases of mitral and aortic valve replacement, 31 cases of aortic valve replacement, 70 cases of mitral valve replacement, and 5 cases of tricuspid valve replacement. The causes of re-valve replacement surgery were as follows: mechanical valve failure in 62 cases, perivalvulaRleakage in 27 cases, bioprosthetic valve failure in 26 cases, and bioprosthetic valve dysfunction in 3 cases. Results Eight cases died during the perioperative period, with a mortality of 6.8%. The causes of death were multiple organ failure, malignant arrhythmia, and severe low cardiac output syndrome. Postoperative complications occurred in1 9 cases, with an incidence rate of1 6.1%. Conclusion Compared with the first valve operation, re-valve replacement surgery has great difficulty in operation, heavy blood loss, and high incidence rate of postoperative complications and mortality. The majoRcauses of re-valve surgery are mechanical valve failure, perivalvulaRleakage, and bioprosthetic failure.