共查询到20条相似文献,搜索用时 15 毫秒
1.
Toshiyuki Katogi Ryo Aeba Yasunori Cho Yoshito Inoue Atsuhiro Mitsumaru Shigeyuki Takeuchi Shiaki Kawada 《General thoracic and cardiovascular surgery》1999,47(2):63-67
We present our experience in mitral valve replacement (including left-sided tricuspid valve in corrected transposition) in patients younger than 6 years of age. The long term results were examined with special focus on re-replacement of the valve. Between 1974 and 1995, we performed mitral valve replacement in 14 patients younger than 6 years of age, with no operative mortality. There were 3 late deaths, caused by endocarditis, valve thrombosis, and congestive heart failure, respectively. The five-year-survival rate after primary replacement was 85%, and the ten-year-survival rate was 75%, using Kaplan-Meier analysis. Ten patients (11 occasions) required repeated mitral valve replacements at 2 months to 17 years after the original replacement. The indication for the second or third mitral valve replacement was paravalvular leakage (2 patients), valve thrombosis (1 patient), degeneration in the porcine prosthesis (3 patients), and patient outgrowth of the original small prosthesis (5 patients). Again there was no operative mortality. One patient who suffered from multiple occasions of valve thrombosis died at two years after the second replacement. All patients who had outgrown the prosthetic valve received larger prosthesis at the second replacement than at the primary replacement. The actuarial percentage of freedom from valve-related events at 3 years, 5 years, and at 10 years, was 50%, 37%, and 8%, respectively. Conclusions: Mitral valve replacement in patients younger than 6 years of age can be performed relatively safely, but meticulous follow-up and appropriate decision making for re-replacement is mandatory for the long-term survival of these patients. 相似文献
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Rita Karianna Milewski Andreas Habertheuer Joseph E. Bavaria Stephanie Fuller Nimesh D. Desai Wilson Y. Szeto Varun Korutla Prashanth Vallabhajosyula 《The Journal of thoracic and cardiovascular surgery》2019,157(2):714-725
Objective
Long-term outcomes of prosthetic aortic valve/root replacement in patients aged 30 years or younger are not well understood. We report our single institutional experience in this young cohort.Methods
From 1998 to 2016, 99 patients (age range, 16-30 years) underwent aortic valve replacement (n = 57), aortic valve replacement and supracoronary ascending aorta replacement (n = 6), or aortic root replacement (n = 36). A prospectively maintained aortic valve database was retrospectively reviewed to complete longitudinal functional and clinical data. Total follow-up was 493 patient years.Results
Surgical indications included primary stenosis/insufficiency (52% [n = 51]), Marfan syndrome (10% [n = 10]), and endocarditis (33.3% [n = 33]). Fifty-eight patients (59%) underwent mechanical valve replacement, with 41 patients (41%) receiving a biologic/bioprosthetic valve. Twenty-five patients underwent aortic valve reoperation after index procedure with following indications: prosthesis–patient mismatch 1.0% (n = 1), prosthetic valve degeneration/dysfunction 10% (n = 10), connective tissue 2% (n = 2), and endocarditis 12% (n = 12). Mortality (30-day/in-hospital) and stroke rate were 3.0% (n = 3) and 1% (n = 1), respectively. One-, 5-, and 10-year actuarial freedom from aortic valve reoperation by valve type was 89.1%, 84.6%, and 69.4% for the Mechanical Valve group and 89.6%, 70.9%, and 57.6% for the Biologic/Bioprosthetic Valve group, respectively (log rank P = .279). Replacement valve size ≤21 mm was a significant risk factor for reoperation, and was associated with progression of mean aortic valve transvalvular gradients over follow-up. Valve type had no effect.Conclusions
The choice of mechanical versus biologic/bioprosthetic valve does not affect freedom from reoperation or survival rates in this young cohort during mid- to long-term follow-up. Smaller aortic valve replacement size (≤21 mm) is a significant risk factor for reoperation and progression of mean aortic valve gradients. 相似文献3.
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Naoki Wada Yukihiro Takahashi Makoto Ando In-Sam Park Toshio Kikuchi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2005,53(10):545-550
OBJECTIVE: This study was undertaken to review our experience of mitral valve replacement in children under 3 years of age. METHODS: Between January 1990 and May 2004, 18 patients under 3 years of age underwent a total of 20 mitral valve replacements using a bileaflet mechanical prosthetic valve. There were 9 males and 11 females. The age at surgery ranged from 3 months to 3 (mean=1.02 +/- 0.72) years and body weight varied between 3.4 and 13.2 (mean=7.08 +/- 2.74) kg. RESULTS: There were 4 early and 2 late deaths, and these occurred in severe cases aged less than 1 year of age. Re-replacement of mitral valve was required in 3 patients (valve thrombosis in 2 and pannus formation in 1). Orifice size of the implanted prosthesis (OS) as compared with the predicted normal size of the mitral valve (NS) was well correlated with maximum transprosthetic flow velocity estimated by Doppler echocardiography. In this study, the OS/NS>0.65 was maintained in all patients, and none required re-replacement because of prosthesis-patient mismatch. CONCLUSION: Patients less than 1 year of age had significant mortality and morbidity. The results were satisfactory in the remainder (1-3 years). During this follow-up period, none required re-replacement due to somatic growth, but it will be an unavoidable problem in the future. The OS/NS, which can be checked with a regular physical examination, may serve as a guide to determine the most appropriate timing for the second surgery. 相似文献
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Naoki Wada Yukihiro Takahashi Makoto Ando In-Sam Park Toshio Kikuchi 《General thoracic and cardiovascular surgery》2005,53(10):545-550
Objective: This study was undertaken to review our experience of mitral valve replacement in children under 3 years of age. Methods: Between January 1990 and May 2004,18 patients under 3 years of age underwent a total of 20 mitral valve replacements using a bileaflet mechanical prosthetic valve. There were 9 males and 11 females. The age at surgery ranged from 3 months to 3 (mean=1.02±0.72) years and body weight varied between 3.4 and 13.2 (mean=7.08±2.74) kg. Results: There were 4 early and 2 late deaths, and these occurred in severe cases aged less than 1 year of age. Re-replacement of mitral valve was required in 3 patients (valve thrombosis in 2 and pannnus formation in 1). Orifice size of the implanted prosthesis (OS) as compared with the predicted normal size of the mitral valve (NS) was well correlated with maximum transprosthetic flow velocity estimated by Doppler echocardiography. In this study, the OS/NS>0.65 was maintained in all patients, and none required re-replacement because of prosthesis-patient mismatch. Conclusion: Patients less than 1 year of age had significant mortality and morbidity. The results were satisfactory in the remainder (1–3 years). During this follow-up period, none required re-replacement due to somatic growth, but it will be an unavoidable problem in the future. The OS/NS, which can be checked with a regular physical examination, may serve as a guide to determine the most appropriate timing for the second surgery. 相似文献
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Christopher W. Baird Mariana Chávez Lynn A. Sleeper Michele J. Borisuk Emile A. Bacha Luke Burchill Kristine Guleserian Michel Ilbawi Khanh Nguyen Anees Razzouk Takeshi Shinkawa Minmin Lu Stephanie M. Fuller 《The Journal of thoracic and cardiovascular surgery》2021,161(2):345-362.e2
ObjectivesTo assess the difference in time to and predictors of reintervention according to valve type in surgical bioprosthetic pulmonary valve replacement (PVR) in patients younger than 30 years of age from multiple centers.MethodsData were retrospectively collected for 1278 patients <30 years of age undergoing PVR at 8 centers between 1996 and 2015.ResultsMean age at PVR was 19.3 ± 12.8 years, with 719 (56.3%) patients ≤18 years of age. Diagnosis was tetralogy of Fallot in 626 patients (50.5%) and 165 (12.9%) had previous PVR. Median follow-up was 3.9 years (interquartile range, 1.2, 6.4). Multiple valve types were used, most commonly CE PERIMOUNT, 488 (38.2%), CE Magna/Magna Ease, 361 (28.2%), and Sorin Mitroflow 322 (25.2). Reintervention occurred in 12.7% and was most commonly due to pulmonary stenosis (68.8%), with most reinterventions occurring in children (85.2%) and with smaller valve sizes (P < .001) Among adults aged 18 to 30 years, younger age was not a significant risk factor for reintervention. Surgical indication of isolated pulmonary regurgitation was associated with a lower risk of reintervention (P < .001). Overall, 1-, 3-, 5-, and 10-year freedom from reintervention rates were 99%, 97%, 92%, and 65%. The only independent risk factors for reintervention after controlling for age and valve size were lack of a concomitant tricuspid valve procedure (P = .02) and valve type (P < .001); Sorin and St Jude valves were associated with similar time to reintervention, and deteriorated more rapidly than other valve types.ConclusionsIn this large multicenter study, 8% of patients have undergone reintervention by 5 years. Importantly, independent of age and valve size, reintervention rates vary by valve type. 相似文献
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Colorectal cancer in patients younger than 40 years of age 总被引:5,自引:0,他引:5
Keswani SG Boyle MJ Maxwell JP Mains L Wilks SM Hunt JP O'Leary JP 《The American surgeon》2002,68(10):871-876
Previous studies have suggested a poor outcome for patients presenting with colorectal cancer under the age of 40 years. This study was conducted to evaluate the outcomes of these patients during a 10-year period at the Medical Center of Louisiana in New Orleans. A retrospective study was designed to review all patients under the age of 40 with a diagnosis of colorectal cancer from January 1990 to December 2000. There were 664 patients presenting with colorectal cancer during the 10-year period; of these 24 presented for surgery under the age of 40. There were 17 male and seven female patients. The median age was 35 years (range 22-39). Eleven (44%) patients had a positive family history of colorectal cancer. Seven lesions were right sided, one transverse, eight left sided, and eight rectal. Histologically 20 lesions were typical adenocarcinomas and four were mucinous. Twelve were stage IV, six stage III, five stage II, and one stage I. Twenty-one patients underwent resection, six with stoma formation; three patients had stoma formation only for a total of nine stomas (38%). The mean operative duration was 3.3 +/- 1.9 hours. The operative mortality was 4 per cent with a complication rate of 17 per cent. The eight rectal cancer patients received preoperative chemoradiation therapy (33%). Twelve (50%) patients with colon cancer received postoperative 5-fluorouracil-based chemotherapy. The mean survival for all patients was 24.7 +/- 23.2 months. Estimated 5-year survival using Kaplan-Meier analysis was 30 per cent. We conclude that colorectal cancer patients less than 40 years of age present at an advanced stage and tend to have a positive family history. In general patients tolerate surgery well, with stoma formation in more than one-third. Long-term survival is as predicted for their advanced stage of presentation. The study highlights the need for early diagnosis in this patient group. 相似文献
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W R Jamieson R T Miyagishima G L Grunkemeier E Germann C Henderson S V Lichtenstein H Ling A I Munro 《Canadian journal of surgery》1999,42(1):27-36
OBJECTIVE: To determine major thromboembolic and hemorrhagic complications and predictive risk factors associated with aortic valve replacement (AVR), using bileaflet mechanical prostheses (CarboMedics and St. Jude Medical). DESIGN: A case series. SETTING: Cardiac surgical services at the teaching institutions of the University of British Columbia. PATIENTS AND METHODS: Patients 2 age groups who had undergone AVR between 1989 and 1994 were studied. Group 1 comprised 384 patients younger than 65 years. Group 2 comprised 215 patients 65 years of age and older. RESULTS: The linearized rates of major thromboembolism (TE) occurring after AVR were 1.54%/patient-year for group 1 and 3.32%/patient-year for group 2; the rates for major TE occurring more than 30 days after AVR were 1.13%/patient-year for group 1 and 1.55%/patient-year for group 2. The crude rates for major TE occurring within 30 days of AVR were 1.04% for group 1 and 3.72% for group 2. The death rate from major TE in group 1 was 0.31%/patient-year and in group 2 was 0.88%/patient-year. Of the major TE events occurring within 30 days, 100% of patients in both age groups were inadequately anticoagulated at the time of the event, and for events occurring more than 30 days after AVR, 45% in group 1 and 57% in group 2 were inadequately anticoagulated (INR less than 2.0). The overall linearized rates of major hemorrhage were 1.54%/patient-year for group 1 and 2.21%/patient-year for group 2. There were no cases of prosthesis thrombosis in either group. The mean (and standard error) overall freedom from major TE for group 1 patients at 5 years was 95.6% (1.4%) and with exclusion of early events was 96.7% (1.3%); for group 2 patients the rates were 90.0% (3.2%) and 93.7% (3.0%), respectively. The mean (and SE) overall freedom from major and fatal TE and hemorrhage for group 1 patients was 90.1% (2.3%) and with exclusion of early events was 91.2% (2.3%); for group 2 patients the rates were 87.9% (3.1%) and 92.5% (2.9%), respectively. The 5-year rate for freedom from valve-related death for group 1 patients was 96.3% (2.1%) and for group 2 patients was 97.2% (1.2%). CONCLUSION: The thromboembolic and hemorrhagic complications after AVR with bileaflet mechanical prostheses occur more frequently and result in more deaths in patients 65 years of age and older than in patients years younger than 65 years. 相似文献
11.
BACKGROUND: Mitral valve replacement in patients who previously had undergone aortic valve replacement is a technical challenge. The rigid aortic prosthesis limits visualization of the anterior mitral annulus and placement of sutures. METHODS: Reoperative mitral valve replacement was performed in five patients after aortic valve replacement. Two patients underwent resternotomy to allow verification of normal aortic prosthetic valve function. Anterolateral right thoracotomy was used for reentry in the remaining three patients. Exposure of the anterior mitral annulus was accomplished by initial traction on the intact anterior leaflet, with resection of this leaflet only after placement of sutures. RESULTS: All patients survived the surgical procedure and are well 2 to 30 months after operation. In one patient it was impossible to open one cusp of the mitral prosthesis, nor was it possible to rotate the valve. The valve was reimplanted, but sutures were tied only after testing for full free cusp motion. CONCLUSIONS: When appropriate, right thoracotomy incision offers excellent exposure of the mitral valve with minimal dissection. Placement of sutures along the anterior portion of the annulus is facilitated by traction downwards on the anterior leaflet. Full range of motion of the prosthetic cusps should be verified before tying the sutures. 相似文献
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H Furukawa T Iwanaga S Imaoka M Hiratsuka I Fukuda T Kabuto O Ishikawa Y Sasaki 《European surgical research. Europ?ische chirurgische Forschung. Recherches chirurgicales européennes》1989,21(6):313-318
To identify the high-risk group having a large number of cancerous lesions in the stomach, the histopathological characteristics of multifocal gastric cancer in 38 young patients (49 years old or younger, group A) were studied and compared with 204 older patients (at least 50 years old, group B). In terms of the number of foci, patients with over 4 foci (high-risk patients) were more frequent in group A (20%) than in group B (5%, p less than 0.05). In 80% of the patients in group A, each focus was near the borderline of both glands (pyloric and fundic glands) and was not always surrounded by intestinal metaplasia, while in 70% of the group B patients the lesions were scattered throughout the stomach and were surrounded by intestinal metaplasia. The carcinogenesis of multifocal cancer in group A, which differs from that in group B, might be stimulated by some strong carcinogenic promoters. 相似文献
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Burns JP Snyder SJ 《Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]》2008,17(1):90-96
Thirty-seven patients (41 shoulders) younger than 50 years of age (mean age, 43.7 years) underwent all-arthroscopic repairs of rotator cuff tears between 1994 and 2002. With a minimum 3-year follow-up (average 69 months, range 37-161 months), postoperative function was assessed by means of a UCLA scoring system, range of motion measurements, strength exam, and VAS pain score. Tears were categorized into 4 groups by type and size: partial undersurface tears, complete tears that were small (<1 cm), medium (1-3 cm), or large/massive (4-5 cm). All but 1 patient (97%) was subjectively satisfied and felt to be improved postoperatively. Average postoperative UCLA score improved significantly, and 95% of the shoulders achieved good or excellent postoperative results. Postoperative pain scores and strength evaluation also improved significantly. There was no significant loss of motion postoperatively and outcomes were independent of tear size and type. To date, there have been no revisions. These treatment results suggest that arthroscopic management in patients younger than 50 can achieve predictably good to excellent results regardless of tear size. 相似文献
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Mitral valve replacement six years after cardiac transplantation 总被引:1,自引:0,他引:1
J G Copeland L J Rosado G Sethi C Huston R W Lee 《The Annals of thoracic surgery》1991,51(6):1014-1016
A 33-year-old man found to have increasing mitral regurgitation and decreasing exercise tolerance 6 years after cardiac transplantation received a mitral bioprosthesis. For 8 months he has been without complications from the valve replacement and is clinically and hemodynamically considerably improved. 相似文献
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Novel technique of valve-sparing aortic root replacement in two children younger than 3 years of age
Kirklin JK Johnson WH Cook BB Law MA McMahon WS Romp RL Colvin EV 《The Annals of thoracic surgery》2012,94(1):299-301
A novel technique of valve-sparing aortic root replacement was applied to 2 children younger than 3 years of age with Marfan syndrome and large aortic root aneurysms. Using elements of both the remodeling and reimplantation techniques, circumferential rings from a 20-mm to 22-mm polyester graft provide stabilization at the subannular and sinotubular levels, and bovine pericardial patches create pseudosinuses. Follow-up at 2 years in 1 patient and 7 months in a second patient revealed satisfactory valve function with stable aortic root size. 相似文献
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40岁以下青年人直肠癌患者的预后因素分析 总被引:4,自引:3,他引:4
目的探讨影响青年人直肠癌预后的因素。方法分析一个肿瘤中心10年间经手术治疗的168例40岁以下直肠癌病例的临床病理特征,对影响患者生存的多种因素进行了单因素及多因素分析。结果168例中,病理根治术(R0)130例(77.4%),镜下切端阳性(R1)12例(7.1%),大体标本切端阳性(R2)26例(15.5%)。低位前切除术57例,Miles术89例,单纯行乙状结肠造瘘术22例;手术死亡率为0。随访期间发生肝转移10例,肺转移6例,骨转移1例。81例患者于术后87个月内死于复发和转移。患者的平均生存时间为(67.0±3.8)个月。5年和10年总生存率分别为44.3%及37.0%。单因素分析表明,术式、肿瘤根治度、肿瘤病理类型、肿瘤直径、肿瘤侵犯深度、淋巴结转移、远处转移、肝转移及TNM分期为影响预后的因素;多因素回归分析显示,仅有肿瘤根治度及淋巴结转移是影响患者术后生存的独立因素。结论影响直肠癌患者术后生存的因素为术式、肿瘤的根治度、病理类型、肿瘤直径、肿瘤侵犯深度、淋巴结转移、远处转移、肝转移及TNM分期。其中独立影响因素仅有肿瘤的根治度及淋巴结转移。 相似文献
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目的探讨非骨水泥型全髋关节成形术(THA)在小于60岁国人中应用的长期结果。方法从1998年到2001年,一项前瞻性调查58例初次THA在小于60岁患者的结果,平均随访时间为11.1年(3.3~13.3年)。结果本组患者手术前的Harris评分平均为36.9(6~62)分,在最后评估的Harris评分平均为88.3(35~100)分。采用无菌性松动为失败标准,这种非骨水泥型THA在13.3年的假体生存率为97.9%。结论非骨水泥型THA在小于60岁患者有优良的长期结果。 相似文献