再次心脏手术二尖瓣替换术77例临床分析

目的：报告再次心脏手术二尖瓣替换术77例的治疗经验。方法：77例中二尖瓣闭式扩张术后再狭窄56例，生物瓣替换术后瓣膜毁损15例，机械瓣替换术后瓣膜功能障碍4例，部分房室管畸形术后二尖瓣关闭不全1例，房间隔缺损术后风湿性二尖瓣病变1例。55例在体外循环心脏停搏下手术，22例在浅低温体外循环心脏跳动下进行手术。结果：手术早期死亡4例（死亡率5．2％）。晚期死亡2例。随访存活病人心功能明显改善。结论：病人术前心功能是导致再次手术二尖瓣替换术后并发症和死亡率的重要因素，心脏跳动下进行手术可简化手术过程，改善心肌保护，减少并发症的发生。

Reoperations on mitral valve replacement in 77 cases

Objective To review the reoperations on mitral valve replacement in 77 cases. Methods In the 77 cases of reoperations 56 suffered from restenosis after closed mitral commissarotomy, 15 with structural destruction after bioprosthese replacement, 1 with severe mitral valve incompetence after repair for partial atrioventricular canal defect, and 1 with rheumatic mitral valve diseases after repair for atrial septal defect. Fifty five cases were undergone mitral valve replacements on arrested heart with moderate hypothermic cardiopulmonary bypass, and the others on beating heart with mild hypothermic cardiopulmonary bypass. Results The early stage postoperative mortality was 5.2% (4 of 77 cases), 2 patients died during following up period. The cardiac function states in the survivors were significantly improved. Conclusion The preoperative cardiac function states are the major detrimental factor predisposing postoperative convalescences. Reoperations on mitral valve replacement on beating heart might fascinate operation, and ameliorate myocardial ischemic reperfusion injury during operation.