再次心瓣膜置换术105例的临床分析  

Reoperation after Mechanical Valve Prosthesis Replacement: An Analysis of 105 Cases

作　　者：过常发[1] 王春生[1] 赵东[1] 洪涛[1] 丁文军[1] 陈昊[1] 赖颢[1] 杨守国[1] 

机构地区：[1]复旦大学附属中山医院心外科上海市心血管病研究所,上海200032

出　　处：《中国胸心血管外科临床杂志》2010年第5期361-364,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市重点学科建设资助项目(B116);Leading Academic Discipline Project of Shanghai(B116)

摘　　要：目的总结人工机械瓣置换术后再次行心瓣膜置换术的临床经验,探讨人工机械瓣置换术后再次心瓣膜置换术的病因、术中技术环节及围术期处理方法。方法自2001年1月至2008年12月共105例人工机械瓣置换术后患者在我中心再次行心脏手术,男59例,女46例;年龄50.2±10.6岁。其中二尖瓣置换术或/＋三尖瓣成形术（TVP）31例,主动脉瓣置换或/＋TVP 38例,Bentall手术（包括全根置换）11例,二尖瓣＋主动脉瓣置换或/＋TVP7例,三尖瓣置换术8例,瓣周漏修补术6例,其它手术4例。再次心脏手术距第一次手术时间为3个月-18年（46.3±31.9个月）。术前心功能分级（NYHA）Ⅱ级27例,Ⅲ级53例,Ⅳ级25例。结果手术死亡6例,总病死率5.71%（6/105）,其他患者术后心功能均恢复到Ⅰ-Ⅱ级。死亡原因为：术后多器官功能衰竭1例,术前心功能Ⅳ级、术后严重低心排血量1例,术后假性动脉瘤破裂1例,严重脑部并发症导致感染1例,人工瓣膜心内膜炎（PVE）2例。人工机械瓣置换后再次心瓣膜置换术原因为：瓣周漏67例（63.80%）,PVE 16例（15.23%）,血栓形成14例（13.33%）,继发其它瓣膜病变8例。术后随访11-107个月,因心搏骤停、脑出血远期死亡2例。结论机械瓣置换术后有一定的再手术率,其再次心瓣膜置换术的重要原因包括：瓣周漏、人工瓣膜心内膜炎和血栓形成。充分的术前准备、正确手术时机的选择、不同体外循环方法的应用及合理的术中技术环节的应用是手术成功的关键。Objective To summarize our operative experiences of cardiac reoperation after mechanical valve prosthesis replacement and investigate the causes of reoperation and the perioperative techniques and operation methods. Methods From January 2001 to December 2008,we performed reoperation on 105 patients（59 males and 46 females,aged 50.2±10.6 years old） who had undergone mechanical valve prosthesis replacement.Among the patients,there were 31 cases of mitral valvular replacement（＋ tricuspid valvular plasticity）,38 cases of aortic valvular replacement（＋ tricuspid valvular plasticity）,11 cases of Bentall procedure,7 cases of mitral and aortic bivalvular replacement（＋tricuspid valvular plasticity）,8 cases of tricuspid valvular replacement,6 cases of repairing of prosthetic leakage,and 4 others cases.The time interval between two operations was 3 months to 18 years（46.3 ±31.9 months）.Before reoperation,the cardiac function （NYHA） of the patients was class Ⅱ in 27 patients,class Ⅲ in 53 patients,and class Ⅳ in 25 patients. Results There were 6 hospital deaths with a mortality of 5.71%（6/105）.All others recovered to NYHA class Ⅰ-Ⅱ. The causes of mortality included 1 case of multiple organ failure,1 case of low cardiac output after operation,1 case of aortic pseudo-aneurysm rupture,1 case of severe infection due to brain complication and 2 cases of prosthetic valve endocarditis（PVE）.The causes for cardiac reoperation after mechanical valve prosthesis replacement were 67 cases of prosthetic leakage（63.80%）,16 cases of PVE（15.23%）,14 cases of prosthetic thrombosis（13.33%） and 8 cases of other valvular anomalies.Follow-up was done for 11 to 107 months,which showed two cases late deaths of cardiac arrest and cerebral hemorrhage. Conclusion Patients who have received mechanical valve prosthesis replacement may undergo cardiac reoperation due to paravalvular prosthetic leakage,paravalvular endocarditis,and prosthetic thrombosis.The keys to a successful cardiac reoperatio

关 键 词：人工机械瓣膜置换术 再次心脏手术 瓣周漏 人工瓣膜心内膜炎 

分 类 号：R654.2[医药卫生—外科学]