摘要
目的 对近几年瓣膜置换术后失功再手术治疗的47例进行讨论。方法 本组男22例,女25例,年龄29～60(382±43)岁。第一次替换生物瓣37例,其中二尖瓣30例,主动脉瓣6例,双瓣置换1例;替换机械瓣10例,其中二尖瓣4例,主动脉瓣6例,StJude瓣1枚,MedtronicHall瓣9枚。再手术与初次手术的时间跨度为71～110(964±79)个月,再手术全部替换机械瓣。结果 本组病例顺利脱离体外循环,手术顺利41例,发生严重低心排综合征而安装主动脉气囊内反搏(IABP)6例;术后住院死亡3例,病死率为64%,与同期433例初次瓣膜置换的病死率(23%)相比,差异无显著性(P>005);术中出血和胸腔引流量(5602±475)ml明显高于同期初次手术的引流量(2703±129)ml(P<005)。结论 再次瓣膜置换手术是安全的,与初次心脏瓣膜置换手术一样是可以接受的,并不增加手术的风险。积极而稳妥地掌握手术时机,可有效地提高手术的成功率,并且机械瓣与生物瓣一样存在失功的问题,因此在不增加手术风险的前提下,倡导生物瓣的重新应用。
Objective The definition of security and adequate time for reoperation after primary valve replacement were discussed in 47 patients. Methods 47 cases of failed valve undergone primary valve replacement were investigated. Of 37 cases received bioprosthetic valve replacement including 30 of mitral valve replacement (MVR);6 of aortic valve replacement (AVR); and 1 of double valve replacement (DVR). Of 10 cases received mechanic valve replacement including 4 of MVR,6 of AVR,1 of st Jude, 9 of Medtronic Hall. Failed bioprosthetic and mechanic valves were defined on (67 9±8 8) and (49 2±6 4) months respectively. The distance of reoperation for bioprosthetic valve was (90 2±8 4) months and mechanic was (102 0±5 7) months. All patients received mechanic valves rereplacement. Results 41 procedures were smooth, 6 patients received IABP for low cardiac output syndrome. There were 3 hospital death, the mortality was 6 4%. The total amount of mediastinal and pericardial drainage of blood was (560 2±47 5) ml. Conclusion Reoperation on patients with failed prosthetic valve is safe. Much attention should be paid to the defenition of appropriated time for reoperation.
出处
《安徽医科大学学报》
CAS
1999年第6期445-447,共3页
Acta Universitatis Medicinalis Anhui
关键词
心脏瓣膜置换术
假体失效
再手术
heart valve prosthesis
prosthesis failure
reoperation
