老年人主动脉瓣置换术后病死率分析

目的 对年龄≥70岁的主动脉瓣狭窄患者主动脉瓣置换术后的病死率进行分析.方法 回顾性分析246例年龄≥70岁、并接受主动脉瓣置换的主动脉瓣狭窄患者的临床资料.其中高血压144例(58.5%),心房颤动42例(17.1%),肥胖27例(11.0%),有心脏手术史18例(7.3%).结果 手术30 d内死亡29例,病死率为...     

老年人主动脉瓣置换术后病死率分析

Objective To analyze the mortality in people aged 70 years and over who had undergone aortic valve replacement (AVR) for aortic stenosis.Methods The clinical data of 246consecutive cases aged 70 years and over,who had received AVR,were retrospectively analyzed.The 144 cases (58.5 % ) had hypertension,42 cases ( 17.1 %) had atrial fibrillation,27 cases ( 11.0 % )were obeses,and 18 cases (7.3%) had undergone previous heart surgery.Results The 29 cases (11.8%) were dead within 30 days after operation.Among them,15 cases (8.8%) were with isolated AVR and the other 14 cases (18.7%) were with an associate procedure,the difference was significant (P ＜ 0.05).The rate of postoperative complication was 24 .4%.The commoncomplications were:48 cases (19.5%) with low cardiac output,24 cases (9.8%) with renal dysfunction,52 cases (21.1% ) with prolonged ventilatory support and 12 cases (4.9%) with sepsis.In the Poisson regression analysis,the main predictors of mortality were low cardiac output,renal failure,sepsis and associate procedure.The main predictors of morbidity were CBP time ＞ 120 min,atrial fibrillation and chronic obstructive pulmonary disease.Conclusions The balance between the benefits and risks of the surgery should be well evaluated before deciding to perform AVR.     

老年人主动脉瓣置换术后病死率分析

Objective To analyze the mortality in people aged 70 years and over who had undergone aortic valve replacement (AVR) for aortic stenosis.Methods The clinical data of 246consecutive cases aged 70 years and over,who had received AVR,were retrospectively analyzed.The 144 cases (58.5 % ) had hypertension,42 cases ( 17.1 %) had atrial fibrillation,27 cases ( 11.0 % )were obeses,and 18 cases (7.3%) had undergone previous heart surgery.Results The 29 cases (11.8%) were dead within 30 days after operation.Among them,15 cases (8.8%) were with isolated AVR and the other 14 cases (18.7%) were with an associate procedure,the difference was significant (P ＜ 0.05).The rate of postoperative complication was 24 .4%.The commoncomplications were:48 cases (19.5%) with low cardiac output,24 cases (9.8%) with renal dysfunction,52 cases (21.1% ) with prolonged ventilatory support and 12 cases (4.9%) with sepsis.In the Poisson regression analysis,the main predictors of mortality were low cardiac output,renal failure,sepsis and associate procedure.The main predictors of morbidity were CBP time ＞ 120 min,atrial fibrillation and chronic obstructive pulmonary disease.Conclusions The balance between the benefits and risks of the surgery should be well evaluated before deciding to perform AVR.     

St.Jude Medical Regent主动脉瓣应用于小主动脉瓣环患者的初步经验

目的总结对小主动脉瓣环患者行St.JudeRegent主动脉瓣替换的初步经验。方法对11例小瓣环主动脉瓣病变患者行St.JudeRegent主动脉瓣替换。患者平均年龄(42.9±13.1)岁,体重(68.2±10.1)kg,体表面积(1.71±0.13)m2。术前主动脉瓣跨瓣峰值压差平均(74.4±34.3)mmHg。替换19号St.JudeRegent主动脉瓣7例,21号4例。结果本组患者无手术死亡,无严重并发症。平均输血量227.3ml,4例未输血。随访无远期死亡。术后患者心功能较术前明显改善。术后6个月复查超声心动图,提示肥厚的左心室显著退缩,人工瓣跨瓣峰值压差为(20.8±5.0)mmHg。19号瓣平均有效瓣口面积为(1.68±0.17)cm2,21号瓣为(1.96±0.25)cm2。结论小瓣环主动脉瓣病变患者行St.JudeRegent主动脉瓣替换的近期效果良好。     

钙化性主动脉瓣狭窄的外科治疗

目的评价钙化性主动脉瓣狭窄外科治疗效果及成功因素。方法对26例钙化性主动脉瓣狭窄患者随访分析,年龄55～70岁,平均62岁。主动脉跨瓣压差52～191mmHg,平均97mmHg,室间隔、左室后壁厚度14～19mm,合并关闭不全7例。手术均在全麻、低温和体外循环下行机械瓣置换,同期行Manouguian法扩大主动脉瓣环9例、CABG3例、Wheat术1例。结果术后早期和晚期各死亡1例。随访心脏超声LVEF为51%～72%,室间隔及左室后壁厚度8～12mm,人工瓣跨瓣压差8～26mmHg。心功能为Ⅰ～Ⅱ级。结论瓣膜置换是治疗钙化性主动脉瓣狭窄唯一安全有效的方法,恰当的手术时机、合适的瓣膜型号是提高手术远期疗效的重要保证。     

人工心脏瓣膜置换术297例分析

目的总结我院2001年1月至2007年1月297例心脏瓣膜置换手术临床经验。方法手术在全麻体外循环中度低温下进行，全组共297例，其中行二尖瓣置换术（MVR）152例、主动脉瓣置换术（AVR）46例（其中主动脉根部拓宽主动脉瓣置换8例）、双瓣膜置换术（DVR）97例、三尖瓣置换术（TVR）2例。合并三尖瓣关闭不全（’rR）者行DeVega或Kay成形术，术中同期行冠状动脉搭桥4例、行射频消融Maze手术治疗房颤1例。结果早期死亡10例，死亡率3．4％，其中MVR、AVR、DVR的死亡率分别为2．6％、6．5％和3．1％。结论瓣膜置换术是治疗心脏瓣膜病变的可靠、有效手段。加强围术期处理，选择恰当的手术时机，缩短手术时间，加强心肌保护，提高手术技巧，保留二尖瓣下结构，积极处理三尖瓣反流。主动脉瓣置换时，尽可能置入大一号的瓣膜，减少跨瓣压差，以利术后左室重构，可提高远期疗效，减少术后并发症、降低死亡率，对重症瓣膜病患者尤为重要。     

人工机械瓣膜置换术患者的健康教育

心脏瓣膜置换的患者,病程长,术后需终身服用药物,所以对人工机械瓣膜置换术的患者今后生活和心理都需要健康教育。我科自2002年7月起对65例人工机械瓣膜置换病人实施了系统规范的阶段性健康教育,取得了显著效果现总结如下。1临床资料自2002年7月~2005年7月我科共行瓣膜置换术65例(男26例,女39例),年龄15~75岁,平均年龄45·6岁,其中二尖瓣置换术37例(MVR),三尖瓣置换术1例(TVP),主动脉瓣置换术8例(AVR),MVR AVR 20例,均健康出院。2阶段性健康教育内容2.1由于患者病程长病情逐渐加重,加之手术创伤大及对医院环境陌生等原因,入院后均有不…     

应用新型介入瓣膜行经导管主动脉瓣置入术的实验研究

目的 探讨应用新型介入瓣膜在实验动物体内行经导管主动脉瓣置入术(TAVI)的可行性,并观察新型介入瓣膜置入后的短期效果.方法 选取健康成年绵羊20只,在全身麻醉及成像造影设备的辅助下,经绵羊一侧颈总动脉置入输送鞘管,于主动脉瓣环处释放新型介入瓣膜.以左心室和主动脉造影及经胸超声心动图观察介入瓣膜的位置和作用.记录术后30 d实验动物的存活情况.结果 所有实验绵羊均置入新型介入瓣膜.15只(75％)存活绵羊的术后造影显示介入瓣膜位置良好,无移位,未影响二尖瓣;冠状动脉开口显影良好,冠状动脉通畅.经胸超声心动图显示5例绵羊存在轻度瓣周漏.术后存活绵羊主动脉瓣反流百分比由术前( 1.25±0.46)％增加至(4.52±3.56)％(P＜0.05).术后主动脉瓣有效瓣口面积、主动脉收缩压、主动脉舒张压、平均主动脉压、左心室收缩压、左心室舒张末压、心率与术前比较差异均无统计学意义(P＞0.05).5只(25％)绵羊于TAVI后30 d内死亡,其中介入瓣膜释放展开后即刻,因左冠状动脉开口堵塞发生心室颤动而死亡1只,术后20 min死于急性心肌梗死1只,术后8和12h死于二尖瓣反流2只,术后26 d死于感染性心内膜炎1只.结论 采用新型介入瓣膜在实验动物体内行TAVI是可行的,短期内安全、有效.     

老年心脏瓣膜置换术85例报告

目的总结老年心脏瓣膜置换术的经验。方法对我院1999年1月至2004年7月间60岁以上85例心脏瓣膜病手术患者进行了回顾性总结。风湿性心脏瓣膜病59例,黏液样病变11例,老年退行性瓣膜钙化病变7例,冠心病致二尖瓣关闭不全2例,动脉瘤致主动脉瓣关闭不全4例,先天性心脏病室缺伴主动脉瓣关闭不全1例。结果单瓣置换术61例(其中MVR39例,AVR21例,TVR1例)。双瓣置换术14例,CABG+MVR2例,CABG+AVR4例,Bentall术4例。手术死亡3例(死亡率3.5%)。手术主要并发症是呼吸功能不全13例,肺部感染9例,心律失常25例,心包积液4例,术后肾功能损害5例,低心排4例。结论只要严格手术指征,加强围术期管理,老年心脏瓣膜置换术可取得良好效果。     

人工二尖瓣、主动脉瓣匹配程度对心脏双瓣膜置换术疗效的影响

目的探讨两种人工瓣膜匹配程度对双瓣膜置换术疗效的影响。方法行二尖瓣、主动脉瓣双瓣膜置换术82例,其中两种人工瓣相差2个型号以内（匹配）32例,超过2个型号（不匹配）50例。比较匹配组和不匹配组患者围术期并发症、心功能及早期病死率。结果匹配组术后机械通气6~50 h,发生低心排2例、严重室性心律失常2例、急性肾功能衰竭1例;心功能Ⅰ级22例、Ⅱ级8例;术后死亡2例。不匹配组术后机械通气7~58 h,发生低心排3例、严重室性心律失常2例、急性肾功能衰竭1例;心功能Ⅰ级38例、Ⅱ级9例;术后死亡3例。两组围术期并发症发生率、心功能及病死率相比P均〉0.05。结论 双瓣膜置换术中主动脉瓣与二尖瓣人工瓣膜的选择应根据术中实测瓣环大小、心室容积及患者体质量等因素决定,不宜选择过大型号的人工主动脉瓣。主动脉瓣和二尖瓣人工瓣膜匹配程度对手术效果无直接影响。     

先天性主动脉瓣病变感染性心内膜炎的瓣膜置换术

目的　探讨先天性主动脉瓣病变继发感染性心内膜炎 (CAVE)的外科治疗。方法1990年 5月 1999年 8月间共收治 5 2例CAVE。男 37例 ,女 15例 ,平均年龄 33 3岁。平均心胸比率为 0 5 8,左室舒张末径为 5 3～ 94mm (平均 6 8mm)。瓣膜病理类型以主动脉二瓣化畸形为主 ,占6 8%。术前血培养阳性率为 36 4 %。超声心动图检查结合术后病理检查是诊断CAVE的主要方法。瓣膜赘生物阳性率为 80 8%。心功能 (NYHA)Ⅲ级 2 8例 ,IV级 11例。全组病例均在体外循环下行主动脉瓣置换术 ,均选用机械瓣 (St Jude和Medtronic Hall占 6 0 % )。结果　早期死亡 2例 ,1例死于脑栓塞 ,1例死于 2次瓣膜置换术后瓣周漏严重心功能衰竭。 2例完全性房室传导阻滞均安装永久性心脏起搏器。出院检查体温均正常。平均左室舒张末径为 5 5mm (P <0 0 1)。随访 4 6例 ,平均随访 38个月。 1例术后发生瓣膜功能障碍。无晚期死亡和心内膜炎复发。结论　强调对CAVE早期治疗。术中彻底清除感染病灶 ,结合术后有效抗生素的应用 ,是防止术后心内膜炎复发的关键     

Aortic valve replacement with sutureless and rapid deployment aortic valve prostheses

Aortic valve stenosis is the most common valve disease in the western world. Over the past few years the number of aortic valve re-placement (AVR) interventions has increased with outcomes that have been improved despite increasing age of patients and increasing burden of comorbidities. However, despite such excellent results and its well-established position, conventional AVR has undergone great development over the previous two decades. Such progress, by way of less invasive incisions and use of new technologies, including transcatheter aortic valve implantation and sutureless valve prostheses, is intended to reduce the traumatic impact of the surgical procedure, thus fulfilling lower risk patients’ expectations on the one hand, and extending the operability toward increasingly high-risk patients on the other. Sutureless and rapid deployment aortic valves are biological, pericardial prostheses that anchor within the aortic annulus with no more than three sutures. The sutureless prostheses, by avoiding the passage and the tying of the sutures, significantly reduce operative times and may improve outcomes. However, there is still a paucity of robust, evidence-based data on the role and performance of sutureless AVR. Therefore, strongest long-term data, randomized studies and registry data are required to adequately assess the durability and long-term outcomes of sutureless aortic valve replacement.     

三尖瓣置换术55例临床分析

目的 对５５例三尖瓣置换病例进行了临床分析,以利提高对本病的手术疗效。方法 病因以三尖瓣下移畸形为主（３０例,５４．５％）,并且均存在在严重的前叶发育不良,其次为风湿性心脏病（９例,１６．４％）。三尖瓣置换５９例次,其中机械瓣４６例（占７８％）,生物瓣１３例（占２２％）。二交三尖瓣置换４例。结果 住院死亡１０例患。其中１９９２年以前手术严重右为２８％,１９９２年以后为４％。术后严重右心功能衰竭和     

高龄患者主动脉瓣膜退行性病变生物瓣膜置换手术38例临床总结

目的:探讨高龄主动脉瓣膜退行性病变生物瓣膜置换手术的临床特点。方法:2003年8月至2005年8月,我们对38例>70岁的主动脉瓣膜退行性病变的生物瓣膜置换手术者进行回顾性分析。结果:1例死于术后第二天主动脉破裂,1例脑栓塞合并左侧肢体偏瘫,1例完全性房室传导阻滞,置入永久心脏起搏器。手术后1年随访,心功能明显改善,生活质量满意。结论:高龄主动脉瓣膜退行性病变生物瓣膜置换手术临床效果满意。     

Allograft aortic valve replacement in the adult: a review

Aortic valve replacement using an allograft has been used continuously for over 40 years. Its advantages are excellent haemodynamic function, low thrombogenicity, resistance to infection and avoidance of the complications of anticoagulation. The main concern is its long-term durability, with the high hazard phase for failure between 10 and 20 years. We have only recently been able to judge the true long-term behaviour of the contemporary allograft with two recently published series of patients having reached follow-up beyond 20 years in significant numbers. This review of allograft aortic valve replacement in the adult covers the areas of history, benefits, techniques of sterilisation and preservation, operative methods and outcomes.     

风湿性心脏瓣膜置换术1 061例临床分析

目的:对1061例风湿性心脏病瓣膜置换术进行早期疗效观察及临床分析。方法:对2000年1月～2005年12月入院施行瓣膜置换术的风湿性心脏瓣膜病例进行回顾总结。结果:1061例中,术后早期病死率1.32%(14例),主要死亡原因为低心排血量综合征(3例)和心室颤动(3例)。术后早期并发症发生率6.41%(68例),其中低心排血量综合征13例、严重心律失常12例,两者占36.76%。结论:术前改善心功能、术中加强心肌保护和改进手术方法、积极处理术后并发症是提高风湿性心脏病瓣膜置换术疗效的重要措施。     

主动脉瓣置换术后巨大左心室的恢复

目的