胸腔镜下二尖瓣生物瓣置换术32例分析  

Video-assisted Thoracoscopic Surgery for Bioprosthetic Mitral Valve Replacement in 32 Patients

作　　者：刘健[1] 郭惠明[1] 谢斌[1] 张晓慎[1] 黄焕雷[1] 卢聪[1] 刘菁[1] 庄建[1] 

机构地区：[1]广东省心血管病研究所心外科广东省人民医院广东省医学科学院,广州510080

出　　处：《中国胸心血管外科临床杂志》2014年第5期582-586,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十二五"国家科技计划支撑项目资助(2011BAI11B19)~~

摘　　要：目的探讨胸腔镜下二尖瓣生物瓣置换的经验,评价其临床效果。方法回顾性分析2013年3～12月在广东省人民医院心血管外科行胸腔镜下二尖瓣生物瓣置换术32例患者的临床资料。其中男14例、女18例,年龄19～80（55.6±17.3）岁,体重37～78（55.7±9.7）kg,体表面积1.30～1.95（1.67±0.16）m^2;合并心房颤动5例,术前心功能分级（NYHA）Ⅱ级20例,Ⅲ级11例,Ⅳ级1例;二尖瓣风湿性病变16例,二尖瓣退行性病变11例,感染性心内膜炎4例,合并先天性心脏病1例。结果所有患者均行胸腔镜下二尖瓣生物瓣置换术,其中采用Medtronic HancockⅡ人工生物瓣27例,Medtronic Mosaic生物瓣5例。同期行三尖瓣成形术13例,房间隔缺损修补术1例。全组患者住院期间无死亡,均顺利出院,住院期间未并发低心排血量综合征及左心室破裂。术后复查心脏彩色超声心动图提示,所有患者人工二尖瓣功能良好,无瓣周漏发生。术后患者心功能较术前明显改善,心功能恢复至Ⅰ级9例,Ⅱ级17例,Ⅲ级6例。术后早期及术后3个月左心房内径及左心室舒张期末内径与术前相比均明显减小。而术后早期及术后3个月左心室射血分数（LVEF）与术前相比有所降低。结论胸腔镜下二尖瓣生物瓣置换术创伤小,并发症少,安全可行,使用特殊类型生物瓣可明显减小手术切口大小。Objective To analyze clinical experience and outcomes of video-assisted thoracoscopic surgery （VATS） for bioprosthetic mitral valve replacement （MVR）. Methods We retrospectively analyzed 32 patients who underwent VATS bioprosthetic MVR in the Department of Cardiovascular Surgery of Guangdong General Hospital from March to December 2013. There were 14 males and 18 females with a mean age of 55.6±17.3 years （range, 19 to 80 years）, mean body weight of 55.7 ± 9.7 kg （range, 37 to 78 kg） and mean body surface area of 1.67± 0.16 m2 （range, 1.30 to 1.95 m2 ）. Five patients had atrial fibrillation. There were 20 patients in New York Heart Association （NYHA） functional class Ⅱ, 11 patients in class Ⅲ, and 1 patient in class IV. There were 16 patients with rheumatic mitral valve disease, 11 patients with degenerative mitral valve disease, 4 patients with infective endocarditis and 1 patient with associated congenital heart disease. Results VATS bioprosthetic MVR was successfully performed for all the patients, including 27 patients with Medtronic Hancock Ⅱ Bioprosthesis and 5 patients with Medtronic Mosaic Bioprosthesis. Concomitantly, tricuspid valvu- loplasty was performed for 13 patients and atrial septal defect repair was performed for 1 patient. There was no in-hospital death, low cardiac output syndrome or left ventricular rupture. Postoperative echocardiography showed good bioprosthetic function in all the patients without paravalvular leakage. Postoperative cardiac function significantly improved compared with preoperative cardiac function. There were 9 patients in NYHA functional class Ⅰ , 17 patients in class Ⅱ, and 6 patients in classⅢ . Left atrial diameter and left ventricular end-diastolic diameter examined postoperatively and 3 months after surgery were significantly smaller than preoperative values. Left ventricular ejection fraction （LVEF） examined post- operatively and 3 months after surgery was significantly lower than preoperative LVEF. Conclusions VATS biopro

关 键 词：胸腔镜 二尖瓣置换 生物瓣 

分 类 号：R654.2[医药卫生—外科学]