389例风湿性心脏瓣膜替换术后远期疗效观察

目的 :分析风湿性心脏病瓣膜置换术后远期疗效及其影响因素。方法 :1980年至 2 0 0 0年施行心脏瓣膜置换 4 33例 ,早期死亡 2 7例。术后获访 389例 ,获访时间为 2 16 8病人年 ,平均 5 92病人年。结果 :晚期死亡 35例。晚期死亡率为 1 6 1%病人年。机械瓣和生物瓣晚期死亡率分别为 1 17%和6 10 %病人年 ,15年生存率分别为 89 3%和 4 3 1%。结论 :影响心脏瓣膜置换晚期疗效的主要因素为术前心功、年龄和心房纤颤。机械瓣置换术后晚期死亡原因主要与抗凝有关并发症、心室纤颤、细菌性心内膜炎和心衰有关 ,而生物瓣膜置换术后死亡原因则为生物瓣衰败     

机械心脏瓣膜替换术后低强度抗凝5年随访

目的探讨机械心脏瓣膜替换术后低强度抗凝的可行性。方法回顾性分析63例瓣膜替换术患者5年的临床资料,其中男性27例,女性36例;年龄17～61(43.8±6.7)岁。二尖瓣替换术(MVR)42例,主动脉瓣替换术(AVR)5例,二尖瓣和主动脉瓣双瓣替换术(DVR)15例,三尖瓣替换术(TVR)1例。共用机械心脏瓣膜78枚,其中北京GK-Ⅱ47枚,意大利SorinBicarbon20枚,美国Medtronic-Hall11枚。心功能Ⅱ级6例、Ⅲ级28例、Ⅳ级29例。结果无早期和远期死亡病例,随访183个病人年,心功能恢复到Ⅰ级和Ⅱ级者占98.4%。在PTR1.2～1.7,INR1.2～2.5范围内,无血栓栓塞和瓣膜相关并发症。抗凝有关的出血3例(1.6%/病人年),均发生在瓣膜替换术后1年内,并不需要住院治疗。结论机械心脏瓣膜替换术后低强度抗凝是可行的,一般PTR1.2～1.7,INR1.2～2.5左右。     

St.Jude瓣替换后远期临床结果

目的：评价St．Jude瓣替换后的远期疗效。方法：503例患者植入St．Jude瓣624枚,其中主动脉瓣替换102例,二尖瓣替换280例,主动脉瓣与二尖瓣联合替换121例。对491例出院患者进行信件随访,用Kaplan－meier方法总结其远期并发症发生率。结果：平均随访3．4年,最长随访9年,总随访1444．9人年,随访率为86．00％,远期血栓栓塞率为0．20％人年,与抗凝有关的出血率为0．14％人年,人工瓣性心内膜炎发生率为0．14％人年,晚期死亡率为0．48％人年,所有与瓣膜有关的并发症及死亡的发生率为0．76％人年。9年免除血栓栓塞率为（99±1）％,9年免除与抗凝有关的出血率为（99±1）％,9年免除人工瓣性心内膜炎发生率为（99±6）％,9年生存率为（97±2）％,9年免除与瓣膜有关的并发症及死亡的发生率为（87±8）％。结论：St．Jude瓣替换有较低的血栓栓塞率及较好的远期效果。     

49例儿童心脏瓣膜替换术的经验

目的：报告儿童心脏瓣膜替换术的经验。方法：４９例儿童心脏瓣膜替换者，男３４例，女１５例，年龄５～１４（平均１１６）岁。其中行二尖瓣替换术３２例、主动脉瓣替换术１０例、二尖瓣加主动脉瓣双瓣替换术５例、三尖瓣替换术２例，所用心脏瓣膜均为机械瓣。同期处理合并的心脏病变。结果：术后早期并发症包括：低心输出量综合征５例，呼吸衰竭２例，心律失常２例。其中早期死亡３例，死亡率６１２％。随访０５～１３（平均５４７）年，晚期死亡３例（６５２％）。结论：儿童心脏瓣膜替换时，人工心脏瓣膜尽量选用成人型号，术后常规行华法林抗凝，并要重视对风湿性心脏病瓣膜替换患儿风湿活动的治疗     

心脏瓣膜置换术后患者再次换瓣效果观察

目的观察心脏瓣膜置换术后再次换瓣的效果。方法本组59例患者,其中风湿性心脏病瓣膜替换术后58例,扩张性心肌病左室减容术同时行二、三尖瓣替换术后1例。因机械瓣膜急性功能障碍、人工瓣膜心内膜炎、人工瓣膜瓣周漏及生物瓣衰败出现瓣膜功能缺失者急症行再次换瓣手术,其中5例急症手术时行股动脉插管灌注。换瓣术后瓣周漏6例,4例行再次瓣膜置换术,2例限期直接采用带垫片褥式缝合修补术。生物瓣衰败43例中,23枚猪瓣及25枚牛心包瓣多为不同程度的瓣叶增厚、钙化,同时合并不同程度瓣叶撕裂、穿孔,择期行再次瓣膜替换术及附加手术。结果术后早期死亡2例,出现并发症4例,晚期死亡2例,失访5例。50例心功能恢复至Ⅰ~Ⅱ级。结论 心脏瓣膜置换术后出现严重瓣膜功能缺失者行再次换瓣效果较好。     

单一心脏中心生物瓣膜应用现状

目的 随着生物瓣膜取材、预处理、抗钙化修饰等各个步骤技术工艺的改进和提高,瓣膜使用寿命大大延长,降低了生物瓣膜置换术后的并发症与瓣膜相关并发症,生物瓣膜使用数量不断上升.总结2003-2008年间我院生物瓣膜使用现状.方法 2003年1月至2008年12月,我院共完成单纯心脏瓣膜替换手术1698例,平均年龄为（50±13）岁.其中生物瓣膜替换术858例,平均年龄为（53±9）岁.2003～2008年采用生物瓣/机械瓣的患者例数分别为9/142、18/240、132/155、170/123、240/117、289/63.生物瓣膜所占同期瓣膜手术数量百分比分别为5.96%、7.00%、46.00%、58.02%、67.23%、82.10%.结果 院内死亡共52例,死亡率3.06%（52/1698）.生物瓣替换术后患者死亡20例,总死亡率2.33%（20/858）.2003～2008年生物瓣替换术后死亡率分别为0%、5.56%、2.27%、1.17%、2.08%、2.42%.2003～2008年采用生物瓣替换术后并发症发生率分别为11.11%（1/9）、11.11%（2/18）、9.84%（13/132）、8.82%（15/170）、12.08%（29/240）、5.88%（17/289）.结论 采用生物瓣并没显著影响患者的近期疗效,且无需长期抗凝,大大改善了患者的生活质量.因而,对条件适合、年龄低于60岁的患者,如患者同意接受因生物瓣膜毁损而导致的再手术,可采用生物瓣膜手术.远期疗效尚需进一步随访.     

人造瓣膜心内膜炎:异种生物瓣和机械瓣的比较

近10年来,人造瓣膜心内膜炎的发病率已由原来的10％下降至1～4％,但仍较其他心脏手术引起的心内膜炎高2～3倍。死亡率亦仍高达50～60％。本文就51例人造瓣膜心内膜炎,分析比较生物瓣和机械瓣对心内膜炎的易感性和抗菌素的治疗效果。方法:斯坦福大学医学中心自1963～1977年共作单独二尖瓣替换术和单独主动脉瓣替换术2184例。其中1347例采用各型Starr-Edwards机械瓣。837例采用Hancock生物瓣。总随访时间为7123病人-年。手术方法基本划一。手术前后常规使用抗菌素。具备下列2条标准以上即可诊断为人造瓣膜心     

人工机械瓣膜替换术后晚期死亡原因分析

人工机械瓣膜替换术后晚期死亡原因分析吉林省人民医院心脏外科李惠君，王伯杰，孙成川吉林省人民医院电诊科邱丽，贾雷，江萍随访我院近５年中所施行的１２３例人工机械瓣膜替换术病人。术后晚期（指手术２个月后）死亡者８例，死亡率为６．５％。现就死亡原因及预防方法...     

再次瓣膜替换术后早期与晚期的预后

近年来虽然人造心脏瓣膜的材料与设计有了许多的改进,但引起瓣膜功能障碍的各种并发症仍为瓣膜替换后的一个重要威胁。本文报告蒙特利尔心脏研究所1969～1983年期间,再次瓣膜替换术89例,目的是确定再手术的适应证,分析影响预后的各种因素,评价长期的疗效。病人与方法:在上述13年间,共施行瓣膜替换术2,139例,其中生物瓣1,090例,机械瓣1,049例。再手术者89例(4%),其中机械瓣64例(72%),     

心脏瓣膜置换术206例临床分析

1980年1月至1990年12月,我院施行心脏瓣膜置换术206例。二尖瓣置换术174例,其中再次瓣膜置换术6例;主动脉瓣置换术12例,二尖瓣+主动脉瓣置换术18例;三尖瓣置换术2例。使用猪瓣27只,机械瓣197只。术后早期死亡22例,死亡率为10.7%;晚期死亡16例,晚期死亡率1.9%病人年,机械瓣组为1.08%病人年,猪瓣组为5.6%病人年;10年生存率机械瓣组为92.5%,猪瓣组为62.4%。本文就其疗效评价、瓣膜选择、术后并发症及抗疑问题进行讨论。     

Long-term results after aortic valve replacement in patients with congestive heart failure. Homografts vs prosthetic valves.

OBJECTIVES: The aim of this study was to assess the influence of valve substitute (homograft vs prosthetic valve) on the long-term survival and late valve-related complication rates following aortic valve replacement in patients with aortic valve disease and congestive heart failure. BACKGROUND: The effect of choice of valve substitute on outcome after aortic valve replacement in patients with pre-operative heart failure is unknown. The superior haemodynamic profile of homografts may be of particular benefit. METHODS: We retrospectively analysed pre-operative, operative and follow-up data on 518 adults in functional classes III and IV, who, over the 25 years 1969-1993, had their initial aortic valve replacement at Harefield hospital. Follow-up conducted during 1996 to April 1997 and totalling 4439 patient-years was 96.1% complete. Using multivariate analysis, independent risk factors for different complications and mortality were defined. RESULTS: Overall 5-, 10- and 20-year survival was 80+/-2%, 62+/-2% and 30+/-3%, respectively, with no significant difference between valve types. However, homografts (n=381) independently reduced the rate of serious complications and cardiac death, whereas mechanical valves were an independent adverse risk factor for late mortality. The rates of anticoagulant-related bleeding and thromboembolism were increased by mechanical valves, whereas primary tissue failure was the main complication of homografts. CONCLUSIONS: Long-term outcome of homograft aortic valve replacement in patients with congestive heart failure is acceptable, with a reduced rate of serious complications and cardiac death. Further improvements would be expected if the rate of primary tissue failure could be reduced.     

Preferability of bioprostheses for isolated aortic valve replacement--a comparative study between mechanical and bioprosthetic valves

Comparative long-term performance characteristics of mechanical valves and bioprosthetic valves were analyzed retrospectively among patients who had undergone isolated aortic valve replacement between 1968 and 1987. One hundred sixty-seven patients received either mechanical (n = 82) or bioprosthetic (n = 85) valves. The cumulative follow-up was 926 patient-years (mean 6.1 +/- 4.7 years, ranging from 0.5 to 20.2 years, 100% complete follow-up). Actuarial survival rate, including operative death, at 10 years was 74 +/- 7% for mechanical and 77 +/- 7% for bioprosthetic valve recipients. The rates of freedom from thromboembolism, structural valve failure, prosthetic valve endocarditis, and valve re-replacement at 10 years were 77 +/- 7%, 100%, 96 +/- 2% and 95 +/- 3% for mechanical, and 94 +/- 4%, 83 +/- 8% (p less than 0.05), 88 +/- 5% and 75 +/- 8% (p less than 0.05) for bioprosthetic valve recipients, respectively. Thromboembolism occurred more frequently in the mechanical valve recipients (p less than 0.01), and structural valve failure in the bioprostheses recipients (p less than 0.05). There was no mortality at the time of valve re-replacement. Most of the bioprosthesis recipients received no anticoagulation therapy beyond 3 months postoperatively. Cardiac medication in the late postoperative period was not required in 31.3% of bioprosthetic, and 3.2% of mechanical valve recipients (p less than 0.01). These results show that bioprosthesis in the aortic position exhibits a superb antithrombogenicity and may enable a drug-free state, though its limited durability requires reoperation.     

A 12-year clinical experience of cardiac valve replacement with domestic tilting disc valve prostheses in 1013 cases]

1013 patients with cardiac valve replacement during a 12-year period from 1978 to 1990 were reported. 566 cases were implanted with Shanghai-made tilting disc valve prostheses and 447 with Lanzhou-made (C-L valves). Mitral valve replacement (MVR) in 753 patients, aortic valve replacement (AVR) in 102 and double valves replacement (DVR) in 158. The overall early mortality rate was 6.2% with 4.9%, 7.8% and 11.3% after MVR, AVR and DVR respectively. Follow-up study was made in 3097.43 patient-year (mean 3.26 years). The late death rate was 1.6% patient-years and with 1.4, 1.8 and 3.2 after MVR, AVR and DVR respectively. The incidence of late valve-related complication (% patient-years) were: thromboembolism 0.39, anticoagulant-related hemorrhages 0.77, prostheses failure 0.22, prosthetic valve endocarditis 0.38, periprosthetic leak 0.12, and reoperations 0.38. The domestic tilting disc valve prostheses are considered to be qualified valves with low mortality and satisfactory results.     

Long-term management of patients with cardiac valve prostheses

Marked improvements have been achieved in the results of valve replacement due to recent developments in cardiac valve prostheses, surgical procedures, myocardial protection methods, and supportive techniques. Since 1974, the aortic valve has been replaced with mechanical valves and the mitral valve with biological valves at our institution. During a cumulative follow-up of 1024 patient-years after 306 valve replacements (126 AVR, 148 MVR and 32 AVR + MVR), the 10-year survival rates were 88% for AVR, 72.6% for MVR and 77.5% for AVR + MVR. The cardiac function of 90% of the survivors was evaluated as Class I or II according to NYHA Functional Classification. As for valve-related postoperative complications, thromboembolism was observed in 2.3%/pt-yr, hemorrhage in 0.5%/pt-yr, prosthetic valve endocarditis in 1.3%/pt-yr, perivalvular regurgitation in 1.3%/pt-yr and valve malfunction in 1.1%/pt-yr. Of the causes of late deaths, 62.5% were related to valve complications. Re-replacement of the prosthesis was necessary in 17 patients due to valve-related complications, and early death occurred in 1 (5.9%) of these 17. While cardiac valve replacement contributes to improvements in the quality of the patients' long-term postoperative life, currently employed artificial valves are still not ideal with regard to their materials and design, and re-replacement may become necessary in the late postoperative period. Therefore, in addition to selection of the appropriate valve prosthesis for different disorders and optimal prevention of valve-related complications, early diagnosis by non-invasive techniques and early treatment of these complications if they have occurred are of particular importance for the long-term management of patients following cardiac valve replacement.     

左心瓣膜置换术后远期三尖瓣关闭不全的外科治疗

目的:评价左心瓣膜置换术后三尖瓣重度关闭不全外科治疗效果。方法:对25例左心瓣膜置换术后,人工瓣膜功能正常,三尖瓣重度关闭不全患者行三尖瓣成形术或三尖瓣置换术;首次手术二尖瓣置换术17例,二尖瓣加主动脉瓣置换术8例,在首次手术中10例曾行三尖瓣DeVega法成形术。结果:三尖瓣成形术13例;三尖瓣置换术12例。术后早期死亡4例,病死率16%。随访7个月～8年,平均(5.1±2.6)年,2例三尖瓣置换患者死于心血管事件,长期生存15例,心功能Ⅱ级8例,Ⅲ级4例,Ⅳ级3例,多数仍需强心、利尿药维持,临床症状明显改善。结论:对左心瓣膜置换术后三尖瓣重度关闭不全患者外科手术是一种合适的选择。合理掌握手术指征、手术时机和良好的围手术期治疗是手术成功的关键。     

Prosthetic valve replacement in adolescents with rheumatic heart disease

To assess long-term survival and anticoagulant-related complications after mechanical valve replacement in adolescents with rheumatic heart disease, 88 patients aged 相似文献   

Clinical comparative study between mitral mechanical and bioprosthetic valves--what is the benefit of bioprosthetic valves in the mitral position?

Comparative long-term performance characteristics of mechanical valves and bioprosthetic valves were analyzed retrospectively for patients who had undergone isolated mitral valve replacement from 1967 to 1988. Two hundred ninety-one patients received either mechanical (n = 97) or bioprosthetic (n = 194) valves. The cumulative follow-up was 1,609 patient-years (mean 6.3 +/- 3.8 years, ranging from 0.6 to 20.2 years, 98.9% complete follow-up). The actuarial survival rate, including hospital deaths, at 10 years was 72 +/- 12% for mechanical and 74 +/- 4% for bioprosthetic valve recipients. The rates of freedom from thromboembolism, structural valve failure, prosthetic valve endocarditis, prosthetic valve endocarditis, reoperation, and overall valve-related complications at 10 years were 87 +/- 5%, 100%, 91 +/- 3%, 100%, and 79 +/- 8% for mechanical valve recipients and 85 +/- 3%, 77 +/- 5% (p less than 0.001), 85 +/- 13%, 71 +/- 5% (p less than 0.001), and 52 +/- 5% (p less than 0.001) for bioprosthetic valve recipients, respectively. Thromboembolism occurred at a similar incidence in two types of valves (2.0 +/- 0.7 vs. 2.2 +/- 0.4%/pt-yr). Structural valve failure, reoperations, and overall valve-related events occurred more frequently in the bioprostheses recipients (0 vs. 2.0 +/- 0.4%/pt-yr; p less than 0.001, 0.3 +/- 0.3 vs. 2.9 +/- 0.5%/pt-yr; p less than 0.001, 2.5 +/- 0.8 vs. 5.6 +/- 0.7%/pt-yr; p less than 0.005, respectively). There was no mortality at the time of redo-operation. These results show that bioprostheses in the mitral position exhibit small benefits of antithrombogenesis and prominent disadvantage of poor durability requiring reoperation.     

Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial

OBJECTIVES: The goal of this study was to compare long-term survival and valve-related complications between bioprosthetic and mechanical heart valves. BACKGROUND: Different heart valves may have different patient outcomes. METHODS: Five hundred seventy-five patients undergoing single aortic valve replacement (AVR) or mitral valve replacement (MVR) at 13 VA medical centers were randomized to receive a bioprosthetic or mechanical valve. RESULTS: By survival analysis at 15 years, all-cause mortality after AVR was lower with the mechanical valve versus bioprosthesis (66% vs. 79%, p = 0.02) but not after MVR. Primary valve failure occurred mainly in patients <65 years of age (bioprosthesis vs. mechanical, 26% vs. 0%, p < 0.001 for AVR and 44% vs. 4%, p = 0.0001 for MVR), and in patients > or =65 years after AVR, primary valve failure in bioprosthesis versus mechanical valve was 9 +/- 6% versus 0%, p = 0.16. Reoperation was significantly higher for bioprosthetic AVR (p = 0.004). Bleeding occurred more frequently in patients with mechanical valve. There were no statistically significant differences for other complications, including thromboembolism and all valve-related complications between the two randomized groups. CONCLUSIONS: At 15 years, patients undergoing AVR had a better survival with a mechanical valve than with a bioprosthetic valve, largely because primary valve failure was virtually absent with mechanical valve. Primary valve failure was greater with bioprosthesis, both for AVR and MVR, and occurred at a much higher rate in those aged <65 years; in those aged > or =65 years, primary valve failure after AVR was not significantly different between bioprosthesis and mechanical valve. Reoperation was more common for AVR with bioprosthesis. Thromboembolism rates were similar in the two valve prostheses, but bleeding was more common with a mechanical valve.     

Mechanical valve replacement in congenital heart disease in children

BACKGROUND AND AIM OF THE STUDY: The study aim was to analyze predictive factors of long-term results after mechanical heart valve replacement in children. METHODS: Forty-four patients (19 males, 25 females; mean age 8.9+/-3.9 years, median 7.0 years, range: 1.3 to 15 years) underwent heart valve replacement with mechanical prostheses. Of these patients, 25 had left atrioventricular valve replacement (LavVR) (18 mitral, six tricuspid in corrected transposition of the great arteries (TGA), one common in a univentricular heart), 13 had aortic valve replacement (AVR) and six had tricuspid valve replacement (TVR).The etiology of the valvular disease was congenital in all patients, and complicated by infective endocarditis in seven (16%). Fifteen patients had undergone previous procedures and 16 required simultaneous repair of associated lesions. The mean size of the implanted prosthesis was 26 mm (range: 19-29 mm) for LavVR, 29.7 mm (range: 23-33 mm) for TVR, and 21.9 mm (range: 19-25 mm) for AVR. Postoperatively, all patients received oral anticoagulation. The mean follow up was 6.8+/-3.5 years (total 290 patient-years). RESULTS: There was no early mortality, but three patients (7%) died later; all late deaths occurred in patients with LavVR. There were two sudden deaths, both in patients with complex congenital heart disease and heart failure (before the ACE inhibitor era), and one valve-related death from thrombotic occlusion of a mitral prosthesis. Five patients were reoperated on; three for patient-prosthesis mismatch, one for periprosthetic leak, and one for aortic dissection due to Marfan's syndrome. Thrombotic obstruction occurred in three patients; two in the tricuspid position were treated successfully with thrombolysis, but one in the left atrioventricular position proved fatal. After seven years, the survival rate was 93.4%. CONCLUSIONS: Mechanical heart valve replacement in children aged over one year with congenital heart disease can be performed with satisfactory early and late results. Mechanical valves of >23 mm diameter in the atrioventricular position in the systemic ventricle, and >21 mm in the aortic orifice, can offer excellent long-lasting hemodynamic performance. However, mechanical valves in the tricuspid position are prone to develop thrombotic occlusion.