心脏瓣膜术后同瓣位再次瓣膜手术的临床分析  

Analysis of the same valve position cardiac valve reoperation

作　　者：任瞳 张林 李梁刚 何潇一 文宇 王瑶 姜胜利 Ren Tong;Zhang Lin;Li Lianggang;He Xiaoyi;Wen Yu;Wang Yao;Jiang Shengli(Department of Cardiovascular Surgery,Chinene PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心心血管外科,北京100853

出　　处：《中华胸心血管外科杂志》2022年第6期343-347,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：解放军总后勤部卫生部科研基金(16BJZ28)。

摘　　要：目的总结探讨心脏瓣膜术后同瓣位再次瓣膜手术的外科治疗经验,评价分析手术安全性。方法通过电子病历检索系统,统计2015年1月至2020年11月中国解放军总医院第一医学中心心血管外科重症瓣膜团队同一术者收治的204例再次手术患者中142例瓣膜术后同瓣位功能障碍行再次手术患者的临床资料,进行回顾性分析。纳入标准:瓣膜成形或置换术后再次接受瓣膜置换或成形术者,不包括二尖瓣球囊扩张术后及三尖瓣成形术未置入成形环患者。共纳入142例患者,男60例(42.25%),女82例(57.75%),年龄6~83岁,平均59.4岁。结果同瓣位再次瓣膜手术原因包括:人工瓣膜瓣周漏、人工生物瓣衰败、人工瓣膜感染性心内膜炎、人工瓣膜功能障碍、瓣膜成形术后再次功能障碍;其中常规手术110例,微创全胸腔镜下及胸腔镜辅助手术32例;术后出现脑出血死亡1例,术后凝血功能障碍死亡1例,其余术后低心排血量综合征使用IABP 3例,缺血缺氧性脑病1例,二次气管插管1例,二次开胸止血2例,均治愈出院。术后死亡2例(1.41%,2/142)。结论心脏瓣膜术后同瓣位再次瓣膜手术的原因较多且难度较大,但选择合适的手术方式及围手术期管理可有效降低手术病死率和并发症的发生率,同时微创术式可明显降低手术难度及相关并发症。Objective To summarize the experience of surgical treatment of prosthetic valve dysfunction and evaluate the safety of operation.Methods The clinical data of 142 patients admitted by the same cardiovascular surgeon from January 2015 to December 2019 at the first medical center of Chinese People's Liberation Army General Hospital.The clinical data were retrospectively analyzed,including 60 males(42.25%)and 82 females(57.75%),with an average age of 59.4 years old.Inclusion criteria:patients received redo-valvuloplasty or valve replacement after valvuloplasty or replacement,excluding mitral balloon dilatation and tricuspid valvuloplasty without implantation of annuloplasty ring.Results The reasons of redo heart valve surgery in the same valve position including:bioprosthetic valve failure,mechanical prosthetic valve dysfunction,valve dysfunction after valvuloplasty,prosthetic valve infectious endocarditis,perivalvular leakage.There was 2 death in 142 cases,and the operative mortality rate was 1.41%.The reasons of the perioperative period death include cerebral hemorrhage,coagulation dfsfunction;perioperative complications include low cardiac output syndrome(LCOS),hypoxic-ischemic encephalopathy,respiratory failure,tracheal re-intubation,re-thoratomy for hemaostsis.Conclusion There are many reasons for reoperation of prosthetic valve dysfunction,and the reoperation surgery is a difficult procedure.However,choosing the suitable surgical option,strengthening the perioperative management of such patients can effectively reduce the incidence of postoperative mortality and complications,minimally invasive surgery can reduce the mortality and complications.

关 键 词：心脏瓣膜 再次手术 同瓣位瓣膜功能障碍 临床分析 

分 类 号：R654.2[医药卫生—外科学]