摘要
目的 评价巨大左室 (舒张期末直径 ,EDD >7 0cm)病人心脏瓣膜手术的远期疗效。方法 回顾性分析 1990年 1月至 1998年 12月 114例巨大左室病人心脏瓣膜手术的随访资料。全组术前平均左室收缩期末直径 (ESD) (5 91± 0 5 7)cm ,EDD(8 15± 0 6 2 )cm。手术施行二尖瓣置换 (MVR)和 (或 )二尖瓣成形术 (MVP) (MVRP) 2 8例、主动脉瓣置换 (AVR) 31例、二尖瓣主动脉瓣双瓣置换 (DVR) 5 5例。结果 随访 0 5～ 9年 ,累计随访 34 4病人 年 ,失访 13例 ,随访率为 88 6 0 %。晚期并发症发生率为9 5 9%病人 年 ,其中出血、栓塞和人工瓣心内膜炎的发生率分别为 0 5 8%病人 年、0 87%病人 年和0 2 9%病人 年。晚期病死率为 3 48%病人 年。DVR组显著高于MVRP组和AVR组 (P <0 .0 5 )。术后1、3、5和 8年累积生存率分别为 97 17%病人 年、88 6 6 %病人 年、84 5 %病人 年和 84 5 %病人 年 ,MVRP组和AVR组显著优于DVR组 (P <0 0 5 )。长期生存 89例 ,心功能I级 6 8例、II级 15例和III级 6例。结论 加强术后随访期室性心律失常的防治和心功能支持 ,有助于提高巨大心室病人心脏瓣膜手术的远期疗效。
Objective To evaluate the long-term outcome of hear valve surgery in patients with giant left ventricle(GLV). Method The follow-up data of 114 patients with GLV were analyzed retrospectively between Jan.1990 and Dec.1998. The mean preoperative left ventricular endosystolic dimension and end-diastolic diameters were (5.91±0.57)cm and (8.15±0.62)cm, respectively. Mitral valve replacement or valvuloplasty(MVRP) was performed in 28 cases,aortic valve replacement(AVR) in 31 and double valve replacement(DVR) in 55. Result: The postoperative follow-up interval ranged from 0.5 to 9 years with a cumulative follow-up of 344 patient·years. The overall late complication rate was 9.59% patient·years. The incidence of anticoagulant-related hemorrhage was 0.58% patient·years, thromboembolism 0.87% patient·year and prosthetic endocarditis 0.29% patient·year. Twelve patients died during follow-up giving an overall late mortality rate of 3.48%, which was higher in DVR group than that in MVRP and AVR groups (P<0.05). The 1,3,5 and 8-year survival rates were 97 17%, 88 66%, 84 50% and 84 50%, respectively. The survival rate was lower in DVR group than that in MVRP and AVR groups (P<0.05). Of 89 long-term survivors, 68 patients were in NYHA functional class I, 15 in class II, but 6 still remained class III～IV. Conclusion: Heart function support and the prevention and management of ventricular arrhythmia during follow-up period may improve the long-term outcome of heart valve surgery in patients with GLV.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2000年第4期212-214,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
全军"九.五"医药卫生科研基金!资助 (基金编号96Z0 3 1)
关键词
巨大左心室
远期疗效
心脏瓣膜手术
Heart valve diseases Surgical operative Giant left ventricle Long term effect
