Commando手术在心脏双瓣膜置换术中的应用

Application of Commando Surgery in Cardiac Double Valve Replacement

目的 探讨Commando手术在小瓣环合并主动脉瓣二尖瓣病变患者中应用的有效性和安全性。方法 采用便利抽样的方法选取2021年4月至2022年5月于高州市人民医院心外科行Commando手术(主动脉瓣二尖瓣幕帘扩大手术联合瓣膜置换手术)的患者为研究对象。比较患者术前、术后5 d、术后1个月、术后3个月、术后12个月的临床指标(主动脉瓣环内径、二尖瓣血流速度、二尖瓣跨脉压差、主动脉瓣血流速度、主动脉瓣跨脉压差)和并发症发生情况,分析Commando手术的效果。结果 共纳入12例患者,男2例,女10例,年龄31~72岁,平均(55.75±12.61)岁。患者术后主动脉瓣有效开口面积指数1.24~2.15 cm^(2)/m^(2),术后二尖瓣有效开口面积指数1.53~2.89 cm^(2)/m^(2)。广义估计方程结果显示,主动脉瓣环内径(Z=6.75,P<0.001)、二尖瓣血流速度(Z=-9.35,P<0.001)、二尖瓣跨脉压差(Z=-2.26,P=0.024)、主动脉瓣血流速度(Z=-5.47,P<0.001)、主动脉瓣跨脉压差(Z=-4.82,P<0.001)、六分钟步行试验距离(Z=13.54,P<0.001)在术前、术后5 d、术后1个月、术后3个月、术后12个月差异有统计学意义。术后1年生存率为91.67%,死亡率为8.33%(因发生低心排血容量综合征)。结论 对于小二尖瓣环及小主动脉瓣环且需再次双瓣置换手术患者,Commando手术是安全有效的治疗方案,因人工心脏瓣膜-患者不匹配、瓣膜失功的患者术后获益明显,可避免再次或多次手术治疗,改善患者生活质量。

Objective The effectiveness and safety of Commando surgery in patients with small annulus combined with aortic mitral valve disease provide new clinical ideas and references for the surgical treatment of patients with small annulus,obvious annulus lesions and double valve replacement.Methods Convenience sampling method was used to select patients who underwent Commando surgery(aortic valve mitral valve curtain enlargement surgery and valve replacement surgery) in our hospital from April 2021 to May 2022 as the research objects.The effectiveness of the Commando procedure was analyzed by comparing the patients′ clinical indices(internal diameter of the aortic annulus,mitral inflow velocity,mitral transvenous pressure difference,aortic inflow velocity,aortic transvenous pressure difference) and the incidence of complications before the procedure,at 5 days,1 month,3 months,and 12 months after the procedure.Results A total of 12 patients including 10 females and 2 males with a mean age of 55.75±12.61 years were included.The effective opening area index of aortic valve after operation ranged from 1.24 to 2.15,and the effective opening area index of mitral valve after operation ranged from 1.53 to 2.89.The results of generalized estimation equation showed that there were significant differences in aortic annulus diameter(Z=6.75,P<0.001),mitral valve blood flow velocity(Z=-9.35,P<0.001),mitral valve transpulse pressure(Z=-2.26,P=0.024),aortic valve blood flow velocity(Z=-5.47,P<0.001) and aortic valve transpulse pressure(Z=-4.82,P<0.001) before operation,5 days after operation,1 month after operation,3 months after operation and 12 months after operation.One-year survival rate was 91.67%,and the mortality rate was 8.33%(due to low cardiac output syndrome).Conclusion Commando surgical method is an effective overall solution for patients with small mitral annulus and small aortic annulus.It is a safe and effective treatment for patients undergoing double valve replacement surgery again.Patients with prosthesis-patient mismatch and valve dysfunction have obvious postoperative benefits.It can avoid reoperation or multiple surgical treatments,and improve the quality of life of patients.