胸腔镜微创二尖瓣成形术后再次换瓣的相关因素分析  

Analysis of related factors and management strategies for redo valve replacement after thoracoscopic minimal invasive mitral valve repair

作　　者：王圣 任培军 陈现杰 陆国庆 朱喜亮 李晓洋 程兆云 赵亮 杨雷一 WANG Sheng;REN Peijun;CHEN Xianjie;LU Guoqing;ZHU Xiliang;LI Xiaoyang;CHENG Zhaoyun;ZHAO Liang;YANG Leiyi(Department of Cardiovascular Surgery,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People’s Hospital,Zhengzhou University,Zhengzhou 451464,China)

机构地区：[1]阜外华中心血管病医院、河南省人民医院心脏中心、郑州大学人民医院心外科,451464

出　　处：《心肺血管病杂志》2024年第10期1073-1078,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省医学科技攻关计划项目(201602208)。

摘　　要：目的:探讨胸腔镜微创二尖瓣成形术后再次换瓣的相关因素分析及处理策略。方法:回顾性分析2019年3月至2021年12月,我院收治的103例胸腔镜微创二尖瓣成形患者,术后随访6个月。在术前、术后1周、3个月及6个月,参照心脏病协会(New York Heart Association,NYHA)心功能标准对患者进行心功能评级,并比较术前、术后1周、3个月及6个月患者LVEF、LAD、LVEDD以及二尖瓣反流量,并筛选出成形术后需要再次换瓣的患者,分析首次成形术后主要并发症及患者再次换瓣主要病因。结果:103例患者中首次手术病因为二尖瓣退行性变92例,二尖瓣风湿性改变11例。成形术后5例需要再次换瓣,病因为风湿性病变2例,退行性病变3例。术后早期并发症主要为肺部感染、低氧血症、多脏器衰竭、大量出血、低心排综合征、急性左心衰竭及新发心房颤动。术后6个月随访死亡2例。相较于术前,术后1周患者心功能分级、LVEF、LAD、LVEDD有所恢复,而术后6个月恢复程度显著(P<0.05),但需要再次换瓣的5例患者,无明显改善。结论:风湿性二尖瓣病变以及退行性病变都有可能为胸腔镜微创二尖瓣术后再次换瓣的原因。患者行再次换瓣术时需重点关注高危因素及患者心功能,并选择合适手术方式,术后需做好围术期处理、出院指导以及随访工作。Objective:To explore the analysis of related factors and treatment strategies for redo valve replacement after thoracoscopic minimal invasive mitral valve repair.Methods:The data of 103 patients undergoing thoracoscopic minimal invasive mitral valve repair in our hospital from March 2019 to December 2021 was retrospectively analyzed.The main causes of the patient's redo valve replacement and the main postoperative complications were analyzed.Follow-up was 6 months after operation.Before surgery,1 week after surgery,3 months after surgery,and 6 months after surgery,patients were rated for cardiac function according to the heart function standards of the heart association(NYHA),and LVEF was compared before surgery,1 week after surgery,3 months after surgery and 6 months after surgery.Changes in LVEF,LAD,LVEDD,and mitral valve regurgtation were compared,finding out the reason about redo mitral valve replacement.Results:Among 103 patients,92 cases of mitral valve insufficiency were caused by the first operation,11 cases of mitral valve stenosis with insufficiency.The recurrence of surgery was due to rheumatic mitral valve disease in 2 cases and degenerative valve disease in 3 cases.Early postoperative complications were mainly pulmonary infection,hypoxemia,multiple organ failure,massive bleeding,low cardiac output syndrome,Acute left heart failure and new-onset atrial fibrillation.The results of follow-up 6 months after operation showed that 2 people died.Compared with preoperatively,the patient's cardiac function classification,LVEF,LAD,and LVEDD recovered at 1 week after surgery,while the patient's cardiac function classification,LVEF,LAD,and LVEDD recovered significantly at 6 months after surgery(P<0.05).But for 5 redo mitral valve replacement cases,patient's cardiac function classification,LVEF,LAD,LVEDD and mitral regurgtation didn’t recover after surgery.Conclusion:Both of rheumatic mitral valve disease and degenerative valve disease are probablly reasons for redo valve replacement after thoracoscopic minimal

关 键 词：胸腔镜 微创 二尖瓣形成术 再次换瓣 

分 类 号：R54[医药卫生—心血管疾病]