118例再次或多次心脏瓣膜替换手术

对１１８例再次或多次心脏瓣膜替换术病人行１３５次手术，替换了１４５个人工瓣膜。其中男４８例、女７０例，年龄７～７４岁。初次手术以风湿性瓣膜病居多（８３．９％）。再次手术以人工瓣膜失功为多（７１．７％）。结果示１１８例中早期死亡２９例，晚期死亡１例，总死亡率２５．４２％。其中因手术并发症死亡２３例，占手术死亡人数的７７％。７６例生存者平均随访７．３年，效果良好。结论：掌握手术时机、减少手术并发症是提高手术效果的重要环节

Reoperative Valve Replacement in 118 Patients

Aim:To review the experience of reoperative valve replacement.Clinical material and method:118 patients underwent reoperative valve replacement and totally 145 valve prostheses were implanted from 1978 to 1994.There were 48 males and 70 females.Their age ranged from 7 to 74 years.The mean interval time between initial valve replacement and reoperation was 16.4 years(range,0.5 to 19 years).Reoperation was indicated for prosthetic valve dysfunction in 84 patients(71.2%,biological in 53 and mechanical valve in 31),for perivalvular leak in 23(19.5%)and for bacterial endocarditis in 17(14.4%).Result:There were 29 early deaths and 1 late death with an overall mortality rate of 25.4%.The mortality rate was 16.1% for the first reoperation and 53.3% for second reoperation.The main cause of death were postoperative complications.76 patients survived with good results during the mean follow up of 7.3 years(range,0.5 to 16 years).Conclusion:Timing of reoperative valve replacement and management of postoperative complications are important factors influencing surgical outcome.