广东I型生物瓣行二尖瓣单瓣置换166例(长期随访报告)  

Isolated mitral valve replacement with Guangdong-I porcine bioprostheses in rheumatic heart valve disease: analysis of 166 cases with long-term follow-up

作　　者：张镜芳[1] 简旭华[1] 罗征祥[1] 孙家珍[2] 肖学钧[1] 卢聪[1] 

机构地区：[1]广东省心血管病研究所心外科,广州510080 [2]广东省心血管病研究所心内科,广州510080

出　　处：《中华胸心血管外科杂志》2003年第1期13-15,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨生物瓣二尖瓣单瓣置换后的远期疗效。方法　 16 6例使用广东I型猪瓣(GD I)行风湿性二尖瓣病变单瓣置换病人中男 79例 ,女 87例 ;平均年龄 (2 9 4± 9 9)岁。按年龄分为第1组 (<30岁 ) 84例 ,第 2组 (≥ 30岁 ) 82例。 76 3 %的病人为房颤心律 ,6例术前有脑梗塞病史 ,98%的病人术前心功能为NYHAIII～IV级。结果　 14年累计生存率 (5 2 5± 7 0 ) %。术后 90 %心功能恢复至I～II级。晚期 89例出现瓣衰坏 ,5 9例再手术 ,13年累计瓣膜未衰坏率为 (15 5± 4 3) % ,其中第 2组衰坏率较低。衰坏瓣膜病理改变为严重瓣膜钙化并瓣叶撕裂 ,右冠瓣病变较重。 7例感染性心内膜炎 ,1例脑梗塞。结论　GD I猪瓣能有效治疗风湿性二尖瓣病变 ,改善病人心功能。病例选择应为老年病人。生物瓣膜衰坏率较高 ,制作工艺有待改进。术后感染性心内膜炎应予以足够重视。Objective: To study the long-term effects of mitral valve replacement with bioprostheses in rheumatic heart valve disease. Methods: 166 patients with rheumatic heart valve disease underwent isolated mitral valve replacement from Jan.1978 to Dec.1985. 79 Patients were male and 87 female. Patients' age ranged from 11 to 53 years[mean (29.4±9.9) years]. The patients were classified into two groups: group 1(age<30 years) included 84 patients, group 2(age≥30years) 82 cases. Mean CTR is 0.68±0.08. Most patients were in NYHA function class III-IV. 76.3% of patients had atrial fibrillation. 6 patients had pre-operative cerebral vascular accidents. Postoperative deaths were excluded. Follow-up extended from 0.4 year to 19.4 years. Results: Actuarial estimate of survival rate at 14 years is (52.5±7.0)%. Heart function was improved to class I-II in most of patients. Late structural valve deterioration occurred in 89 patients. Among them, 59 were re-operated. Actuarial estimate of freedom from structural valve deterioration at 13 years is (15.5±4.3)%: group 1 was (10.1±4.9)%, group 2 was (21.5±7.3)%. Valve dysfunction was caused mainly by calcific degeneration as well as cuspal tearing, which was more severe in the right coronary-cusp. 7 had infective endocarditis and 2 had cerebral vascular accidents post-operatively. Conclusions: GD-I porcine bioprostheses performed satisfactorily and has low thrombogenicity. Structural deterioration remains the main cause of valve failure especially in young population. More attention should be drawn to infective endocarditis post-operatively.

关 键 词：广东 心脏瓣膜疾病 风湿性心脏病 心脏瓣膜假体植入 随访研究 

分 类 号：R654.2[医药卫生—外科学]