“衬裙Commando”术用于二次瓣膜置换术近中期疗效的回顾性队列研究  

Short to mid-term results of Chimney Commando in redo valve replacement:A retrospective cohort study

作　　者：刘洪艳 贺必辉[1] 金晶[1] 宋来春[1] 方极辉[1] 周翔 陈艳[1] 陶凉[1] LIU Hongyan;HE Bihui;JIN Jing;SONG Laichun;FANG Jihui;ZHOU Xiang;CHEN Yan;TAO Liang(Department of Cardiac Surgery,Wuhan Asia Heart Hospital,Wuhan,430022,P.R.China)

机构地区：[1]武汉亚洲心脏病医院心外科,武汉430022

出　　处：《中国胸心血管外科临床杂志》2024年第6期860-866,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：武汉市科技局-知识创新专项研究(2022020801010577)。

摘　　要：目的总结双瓣环扩大联合二尖瓣“衬裙”技术(“衬裙Commando”术)在二次瓣膜置换中的应用及近中期疗效分析。方法回顾性分析2019—2022年在武汉亚洲心脏病医院采用“衬裙Commando”术行二次主动脉瓣及二尖瓣(双瓣)置换术患者的临床资料,分析该术式在小主动脉根部患者二次换瓣中应用的安全性、可行性和有效性。结果共纳入49例患者,体表面积为(1.64±0.17)m2,其中女44例、男5例。距离第一次手术时间为(13.10±5.90)年。除4例患者第一次手术方式为瓣膜成形外,其余45例均为瓣膜置换术后患者;41例为双瓣置换术,其中机械瓣39例、生物瓣2例;主动脉瓣多为St.Jude regent 19 mm或St.Jude regent 21 mm,分别占30.61%和34.69%。二尖瓣多为St.Jude 25 mm机械瓣,占65.31%。所有患者均成功进行“衬裙Commando”术,平均主动脉阻断时间(154.00±45.40)min。根据患者意愿选择机械瓣或生物瓣,置入主动脉瓣平均大小(23.90±1.40)mm,二尖瓣(28.20±1.20)mm。术后6个月主动脉瓣跨瓣压差(20.16±5.76)mm Hg。住院期间1例死于多器官功能衰竭。中位随访时间8.00(1.00~24.00)个月,随访期内2例置入永久起搏器,1例死于大面积脑卒中及恶性心律失常。结论“衬裙Commando”术应用于小主动脉根部行二次瓣膜置换的患者安全有效,术后人工瓣膜血流动力学良好,可取得良好的近中期临床效果,远期效果还需进一步随访。Objective To summarize the application of double valve ring enlargement combined with mitral Chimney technique(Chimney Commando)in the secondary valve replacement and to analyze the efficacy in the near and medium term.Methods Patients who underwent the secondary aortic valve and mitral valve(double valve)replacement by Chimney Commando in Wuhan Asia Heart Hospital from 2019 to 2022 were included,and their clinical data were retrospectively collected to analyze the safety and feasibility of this procedure in secondary valve replacement of small aortic root patients.Results A total of 49 patients(44 females and 5 males)were included.The body surface area was 1.64±0.17 m2.The time from the first operation was 13.10±5.90 years.Except for 4 patients whose first operation was valvuloplasty,the remaining 45 patients were all patients after valve replacement,41 patients of double valves replacement,including 39 patients with mechanical valve and 2 patients with biological valve.The majority of the aortic valves were St.Jude regent 19 mm or St.Jude regent 21 mm,accounting for 30.61%and 34.69%,respectively.The mitral valves were predominantly St.Jude 25 mm mechanical valves,making up 65.31%.All patients underwent Chimney Commando double valve ring enlargement,and the mean time of aortic occlusion was 154.00±45.40 min.The mean size of the aortic valve was 23.90±1.40 mm and that of the mitral valve was 28.20±1.20 mm,and the transvalvular pressure difference across the aortic valve was 20.16±5.76 mm Hg at 6 months postoperatively.There was one death during hospitalization due to multiorgan failure.The follow-up time ranged from 1 to 24 months with a median time of 8 months.Two patients were implanted with permanent pacemakers during the follow-up period and 1 patient died due to massive stroke and malignant arrhythmia.Conclusion Chimney Commando is safe and effective in patients with secondary double valve replacement,and the postoperative prosthetic valves have good hemodynamics,and can achieve good clinical results i

关 键 词：人工瓣膜-患者不匹配 双瓣环扩大 二次手术 

分 类 号：R54[医药卫生—心血管疾病]