542例多瓣膜病变手术经验

目的总结多瓣膜病变的手术经验。方法 2001年9月至2008年12月对542例患者行2个或（和）2个以上瓣膜手术。术前心功能（NYHA）III-IV级者392例。MVR＋TVP229例,DVR 205例,DVR＋TVP81例,多瓣膜＋CABG4例,左心房血栓清除、左心耳结扎125例,心脏瓣膜及心内膜SBE赘生物清除19例。结果全组术后死亡10例,占1.85%,其中DVR 5例,MVR＋TVP 3例,DVR＋TVP 1例,DVR＋TVP＋CABG 1例。术后主要并发症发生率21.22%（115/542）,室上性心律失常最常见。结论进一步掌握多瓣膜病变手术指征,完善手术技能,强化围手术期处理,提高多瓣膜病变的手术成功率仍有较多空间。

Clinical therapeutic experience of 542 multi-valves operation

Objective To summarize the experience of multi-valves operation.Methods From September 2001 to December 2008,542 patients who suffered multi-valves disease received heart vavle operation in our hospital.There were 209 males and 333 females.Ages were from 14 to 74 years old,49 cases were ≤30 years old and 39 cases were ≥60 years old.392 patients were in NYHA III～IV before operation.205 cases underwent DVR,229 MVR combined with TVP,81 DVR with TVP,4 multi-valves patients received associated CABG for the serious coronary artery disease.125 cases underwent clearance of left atrium thrombus and deligation of left auricle.19 cases underwent clearance of vegetations in subacute bacterial endocarditis.Results The total mortality was 1.85%(10/542),5 dead cases underwent DVR and 3 underwent MVR with TVP.The indication of complications was 21.22%(115/542).Of all the complications,supraventricular arrhythmia was the most common.Conclusion With experienced perioperative management,more satisfactory results can be achieved if valve operation were performed under sophisticated surgical techniques.