62例双瓣置换病人术后护理体会

目的总结风湿性心脏瓣膜病行二尖瓣、主动脉瓣双瓣置换术的护理经验,进而提高术后监护效果。方法对我院2011年4月至12月施行二尖瓣、主动脉瓣双瓣置换术的62例患者进行回顾性总结。结果手术均顺利完成,术后清醒时间168(60～180)min。瓣膜置换术后早期并发症:低心排量综合征6例,急性肾功能衰竭1例,大出血再次行开胸1例,心律失常6例,肺部炎症3例,其中死亡2例,死亡率为3.3%,死亡原因为术后出现低心排量综合征合并多器官功能衰竭。结论提高术后护理质量,加强对各项指标的监测,减少并发症的发生率,及早发现并处理并发症,是提高风湿性心瓣膜病患者二尖瓣、主动脉瓣双瓣置换术后近远期疗效的保障之一。     

4437例瓣膜置换术住院死亡危险因素分析及安贞风险评分系统建立

目的 对4437例心脏瓣膜置换于术病人进行同顺性研究,定量评估住院死亡的危险因素,建立瓣膜置换手术住院死亡风险模型,以及安贞医院瓣膜置换手术风险评分系统.方法 选取安贞医院心脏外科数据库中收录的主动脉瓣置换术病人848例,二尖瓣置换术病人2202例,主动脉瓣、二尖瓣舣瓣膜置换术病人1387例.选取术前.术中33个临床指标作为住院死亡的可能影响因素,利用单因素分析进行筛选,然后利用多因素分析确立3种手术的住院死亡危险因素并建立风险模型.结果经多因素分析,年龄、体表面积、心功能分级、术前肌酐和体外循环时间是主动脉瓣置换术住院死亡的危险因素.心功能分级、术前心衰史、心胸比率、短轴缩短率、病因、左心室收缩末径,体外循环时间和术中1ABP是二尖瓣置换术住院死亡的危险因素.年龄、心功能分级、术前心内膜炎、糖尿病史、既往二尖瓣球囊扩张术,体重指数和体外循环时间是丰动脉瓣、二尖瓣双瓣膜置换术的住院死亡危险因素.ROC曲线下面积分别为主动脉瓣置换术模型0.921(95%CI,0.874～0.967),二尖瓣置换术模型0.859(95%C1,0.813～0.905),主动脉瓣、二尖瓣舣瓣膜置换术模型0.868(95%CI,0.827～0.908).Hosmer-Leme-show检验显示,主动脉瓣置换术模型χ~2=1.463,P=0.993,二尖瓣置换术模型χ~2=8.720,P=0.366,主动脉瓣、二尖瓣双瓣膜置换术模型χ~2=8.134,P=0.420,预计病死率与实际观测病死率差异无统计学意义.结论 3个模型能够定定量评估瓣膜置换术病人住院死亡风险.     

合并巨大左心室心脏瓣膜置换术62例

目的：总结合并巨大左心室瓣膜病行心脏瓣膜置换术的疗效，探讨影响手术疗效的主要因素及手术适应证选择。方法：1991年5月至2002年7月共为62例瓣膜病合并巨大左心室病人施行了心脏瓣膜置换术，其中主动脉瓣与二尖瓣双瓣置换术56例，二尖瓣置换术5例，主动脉瓣置换加三尖瓣成形术1例；同时行三尖瓣成形术43例，左房折叠术12例。结果：术后早期并发症28例(45．2％)。早期死亡11例(占17．7％)，晚期死亡4例(6．5％)。影响瓣膜置换术早期疗效的主要因素是术前严重左室扩大[收缩末直径(ESD)≥6．0cm和舒张末直径(EDD)≥8．0cm]、严重左室收缩功能下降、射血分数(EF)≤O．40和短轴缩短率(FS)≤0．25，围术期室颤和术后严重低心输出量综合征以及多脏器功能衰竭；影响远期疗效的主要因素是室颤和术前严重左室扩大伴收缩功能下降。结论：提高此类病人手术疗效的关键是选择合适手术时机，妥善处理围术期和术后高危因素。     

心脏瓣膜置换术57例治疗体会

自1999年1月至2006年8月,我们共行心脏瓣膜置换术57例,其中二尖瓣置换术17例,主动脉瓣置换术11例,主动脉瓣与二尖瓣联合置换术29例。现将手术治疗经验报道如下。     

再次直视心脏瓣膜置换术疗效分析

目的 总结再次直视心脏瓣膜置换术的治疗体会.方法 2002年1月至2009年12月完成再次直视心脏瓣膜置换术104例,占同期瓣膜置换手术的2.92%(104/3557).男性53例,女性51例,年龄13～72岁,平均(46±14)岁.心功能(NYHA分级)Ⅱ级7例,Ⅲ级67例,Ⅳ级30例.其中二尖瓣或主动脉瓣置换术后其他瓣膜病变28例,二尖瓣瓣膜成形术后再发二尖瓣关闭不全10例,瓣周漏19例,生物瓣衰败7例,先天性心脏病矫治术再发瓣膜病变18例,人工瓣膜心内膜炎10例,人工瓣膜机械功能障碍9例,其他3例.再次手术方式包括二尖瓣和主动脉瓣双瓣置换2例,二尖瓣置换59例,主动脉瓣置换24例,三尖瓣置换16例,Bentall术3例.两次手术间隔1个月～19年.结果 全组早期死亡8例,早期死亡主要原因为术后低心排血量综合征、肾功能不全或多脏器功能衰竭,病死率7.7%.术中大出血2例,术后再次开胸止血2例,胸骨正中切口感染1例.随访3个月～7年2个月,平均3年4个月.晚期死亡2例,1例抗凝过量颅内出血,另1例原因不明.其余存活患者术后半年随访心功能(NYHA分级)Ⅰ级67例,Ⅱ级27例.结论 再次换瓣手术如恰当掌握手术时机、术中加强心肌保护、保证准确的手术操作、注重围手术期处理,临床近、远期效果满意.     

国产GK型双叶式人工心脏瓣膜的临床应用

目的观察和评价国产GK型双叶式人工心脏瓣膜(GK双叶瓣)植入人体后的早期临床疗效和近期随访结果。方法对61例心脏瓣膜病变患者行人工心脏瓣膜置换术,其中二尖瓣置换术(M VR)34例,主动脉瓣置换术(AVR)16例,二尖瓣和主动脉瓣双瓣膜置换术(M VR+AVR)11例。共植入GK双叶瓣72枚,其中二尖瓣45枚,主动脉瓣27枚;术后监测血液相容性和血流动力学指标,并定期随访和检查是否有与瓣膜相关的并发症发生。结果全组无手术死亡(术后30d内);随访61例,随访1年至2年6个月,远期因外伤死亡1例;其余60例患者术后心功能均从Ⅲ~Ⅳ级转为Ⅰ~Ⅱ级,血流动力学性能及生物相容性良好,生活质量改善。结论GK双叶瓣早期临床应用获得了满意的效果,其近期随访未发现与瓣膜相关的并发症,中、远期结果有待进一步随访观察。     

心瓣膜置换术1407例临床分析

目的　为了不断提高心瓣膜置换术的成功率 ,总结其围手术期的临床经验。　方法　回顾性分析我院1976～ 2 0 0 0年 ,140 7例心瓣膜置换术的手术技术、术后处理以及死亡原因等。　结果　本组二尖瓣置换术 (MVR) 80 6例 ,主动脉瓣置换术 (AVR) 2 32例 ,三尖瓣置换术 (TVR) 4例 ,双瓣膜置换术 (DVR) 333例 ;再次二尖瓣置换术 (Re-MVR) 2 2例 ,再次主动脉瓣置换术 (Re- AVR) 6例 ,再次双瓣膜置换术 (Re- DVR) 4例。全组共死亡 72例 ,总死亡率5 .12 % ;1996年后死亡 14例 ,死亡率 1.87%。　结论　提高手术技术、改进心肌保护方法、加强围术期管理等 ,可大大降低死亡率     

心脏瓣膜置换术36例分析

目的为了不断提高心脏瓣膜置换术的成功率,总结围术期的经验。方法分析我院36例心脏瓣膜置换术的手术经验、围术期处理及死亡原因。结果本组二尖瓣置换术29例,主动脉瓣置换术5例,双瓣置换术6例,三尖瓣置换术1例。死亡1例,死亡率2.78%。结论提高手术技术,改进心肌保护方法,加强围术期管理等,可以提高手术成功率,降低死亡率。     

1 003例瓣膜置换手术围手术期处理

目的总结1003例心脏瓣膜置换手术病例临床特点及围手术期处理经验。方法手术在体外循环中度低温下进行，其中单纯二尖瓣置换术（MVR）555例，主动脉瓣及二尖瓣置换术（BVR）273例，主动脉瓣置换术（AVR）139例，三尖瓣置换术（TVR）26例，三瓣置换术10例。全组病人按≤40岁、41—59岁、≥60岁分为3组，分别为152、572、279例。结果975例（97．2％）恢复出院，死亡28例（2．8％）。3组死亡率分别为3．3％，1．7％，4．7％。死因分别为呼吸循环衰竭11例、多脏器功能衰竭10例、室性心律失常5例、肾功能衰竭2例。发生各种并发症74例次。结论瓣膜置换术是治疗瓣膜病变的有效手段，选择适当的手术时机，改进和完善体外循环技术，加强术中心肌保护，不断改进和提高手术技巧，尽量保留瓣下结构的二尖瓣置换术，能减少瓣膜置换术的手术风险，提高手术疗效。主动脉瓣置换时应尽量去除钙化的瓣叶，置入大一号的瓣膜，减少跨瓣压差，有利于左室重构。术中应常规探查三尖瓣，对瓣环明显扩大的病人予以三尖瓣成形术。心脏大的病人尤应注意围术期电解质的变化，防止发生恶性心律失常。生物瓣的术后抗凝较机械瓣方便，并发症也少，应提高生物瓣的应用比例。围手术期处理得当，可减少术后并发症及降低病死率，老年病人术前合并症多、病情重，应加强围手术期监护。     

非缺血性心脏瓣膜疾病合并冠心病同期手术治疗的临床分析

目的 总结非缺血性心脏瓣膜疾病合并冠心病同期手术患者的临床特征和手术效果,以提高手术疗效. 方法 2000年1月至2007年6月同期手术治疗105例非缺血性心脏瓣膜疾病合并冠心病患者,年龄36～79岁(61.96±7.61岁),其中风湿性心瓣膜疾病59例,退行性二尖瓣病变24例,老年性钙化性主动脉瓣病变13例;其它主动脉瓣病变9例.术前行冠状动脉造影明确诊断98例,术中探查发现冠心病7例.全组均行冠状动脉旁路移植术,共移植血管216支(2.06支/例),同期行二尖瓣置换术36例,二尖瓣成形术15例,主动脉瓣置换术43例,双瓣膜置换术11例. 结果 术后住院死亡6例(5.7%,6/105).死于严重低心排血量3例,肾功能衰竭2例,术后心脏骤停并发多器官功能衰竭1例.术后随访93例,随访时间1个月至7年,失访6例.无晚期死亡患者.心功能分级(NYHA)Ⅰ级25例,Ⅱ级53例,Ⅲ级10例,Ⅳ级5例.1例患者活动后仍有心绞痛存在. 结论 非缺血性心脏瓣膜疾病合并冠心病患者绝大多数无典型的心绞痛症状,50岁以上的患者必须行冠状动脉造影检查,对有冠心病易患因素者,应积极作冠状动脉造影检查;冠心病所致的心肌缺血可明显加重心脏瓣膜疾病所引起的心肌损害,术中心肌保护尤为重要;正确评价术前左心功能低下的患者是选择手术治疗的难点,更是影响手术效果的关键因素.     

Improved early results after heart valve surgery over the last decade

Objectives: This study was undertaken to investigate time trends in early mortality, morbidity and clinical characteristics of patients undergoing heart valve surgery over the last decade. Methods: A regional, prospectively collected, study comprising all patients (2327) undergoing valve surgery in a defined geographical area from January 1990 to December 1999 was conducted. Data were collected from 1746 patients submitted to aortic valve replacement (AVR), 432 to mitral valve replacement (MVR), 78 to double valve replacement (DVR) and 71 to mitral valve repairs. Logistic regression was used to identify risk factors for early mortality. Time trends of early mortality, morbidity and clinical characteristics were analysed. Results: The total early mortality rate was 5.9%; for AVR it was 4.8%, MVR 9%, DVR 14% and mitral valve repair 1.4%. The risk factor profiles for early mortality were similar in all groups of valve interventions, with shock, age over 70 years and advanced NYHA class as the strongest risk factors. There was a decrease in early mortality over the period which remained after correction for risk factors. The proportion of patients over 70 years of age and of patients with diabetes increased, whereas other risk factors were not altered during the study period. Conclusion: It is confirmed that early risks for death after heart valve surgery have decreased. This improvement was consistent after adjustment for risk factors.     

Mid-term surgical results after valve replacement with the carbomedics valve prosthesis

We present herein a review of 95 patients who underwent valve replacement with the CarboMedics (CM) valve prosthesis between April 1990 and December 1992. The operative mortality for the entire group was 4.2%: 0% following aortic valve replacement (AVR), 2.7% following mitral valve replacement (MVR), and 12.5% following double valve replacement (DVR). All patients were prescribed warfarin and bucolome for anticoagulation, and were followed up for a mean period of 29.9 months. Late mortality was 8.4%: 3.1% following AVR, 10.8% following MVR, and 12.5% following DVR. There were no cases of mechanical prosthetic valve failure, significant hemolysis, infective prosthetic valve endocarditis, or bleeding complications. After 44 months of follow-up, the actuarial freedom from complications was calculated as: thromboembolism, 97.8±1.6%; valve thrombosis, 97.8±1.1%; paravalvular leak, 96.7±1.9%; and reoperation, 98.9±1.1%. The overall survival rate was 84.3±6.3% and all survivors showed a significant improvement in NYHA functional class, from 81% in classes III and IV preoperatively to 99% in classes I and II postoperatively. The CM valve exhibited no significant differences in hemolytic parameters or hemodynamic performance after isolated AVR or MVR compared with the similar type of St. Jude Medical bileaflet valve. The evidence provided by the present study therefore suggests that the CM valve prosthesis can achieve excellent mid-term clinical results and hemodynamic performance with a low incidence of thromboembolism and valve thrombosis.     

左心瓣膜置换术后远期三尖瓣关闭不全的外科处理

目的探讨左心瓣膜置换术后远期三尖瓣关闭不全(TR)发生的可能机制以及外科治疗方法的选择和结果.方法 56例左心瓣膜置换术后远期发生TR行再次瓣膜手术的病人,10例人工瓣膜功能正常(A组)者中行二尖瓣置换(MVR)4例,主动脉瓣、二尖瓣双瓣置换(DVR)6例;46例人工瓣膜功能障碍(B组)者中MVR 36例,主动脉瓣置换(AVR)4例, DVR 6例.在A、B两组中,46例第1次手时三尖瓣未见明显异常,10例第1次手术时已行DeVega三尖瓣成形(TVP),第2次手术时发现缝线断裂3例,缝线撕脱7例.56例TR病人再次手术时9例行三尖瓣替换(TVR),其中6例三尖瓣呈风湿性改变;47例行TVP.结果 TVP和TVR各死亡1例,病死率3.6%.54例获随访,随访时间6～132个月,平均(79.4±34.8)个月.8例TVR病人术后心功能恢复良好,46例TVP者40例为轻度TR,5例出现中度TR,仍需强心、利尿药维持,1例再次出现重度TR.结论左心瓣膜置换术后远期TR可能与持续肺动脉高压、右心室不可逆损害、三尖瓣风湿性病变、左心功能的恢复情况以及持续心房纤颤有关.重度功能性TR和三尖瓣风湿性病变者行TVR的疗效可靠.随访发现部分TVP病人功能性TR仍有逐渐加重趋势.     

Long-term clinical results after combined aortic and mitral valve replacement

The results after 282 consecutive double (aortic & mitral) valve replacements (DVR) are compared with our previously reported experience after mitral (MVR, n = 810) and aortic valve replacement (AVR, n = 1753). All but one patient received Bj?rk-Shiley valves. The follow-up which closed on August 1, 1985 was 99.3% and covered 16,869 patient-years (mean 6.3 years/patient). Autopsies were performed in 74% of all fatalities. Early mortality rates were identical in the three patient groups, and late mortality did not differ between MVR and DVR patients. The fraction of valve-related mortality was similar in all groups. Anticoagulant-related bleeding was equally common in all patient groups. The incidences of thromboembolism, reoperation and valve failure did not differ between MVR and DVR patients, but were significantly higher than among AVR patients. With the exception of a slightly increased incidence of prosthetic valve endocarditis, the results after DVR equal those after MVR. In cases with severe mitral valve disease but borderline aortic valve disease, primary DVR is clearly justified and eliminates the need for, and risks of, a secondary AVR.     

Clinical experience with omniscience and omnicarbon prosthetic heart valves

Omniscience valves were implanted in sixty-two patients. Twenty-eight of these patients underwent aortic valve replacement (AVR), 15 had mitral valve replacement (MVR) and 8 had aortic and mitral valve replacement (DVR). Post-operative events occurred in nine (5.9%/patient year) of the AVR group, in three (1.7%/patient year) of the MVR group and in three (5.4%/patient year) of the DVR group. The actuarial freedom from all events at five years in the AVR, MVR and DVR was 74 +/- 8%, 88 +/- 6%, 67 +/- 16%, respectively. Cardiac death occurred in four (2.5%/patient year) of the AVR, one (0.6%/patient year) of the MVR and two (3.6%/patient year) of the DVR. The freedom at five years in the AVR, MVR and DVR was 88 +/- 6%, 96 +/- 4%, and 77 +/- 14%, respectively. Valve-related complications were noted in four patients. Post-operative cerebral hemorrhage was seen in three of the AVR. Maximum opening angle of the Omniscience valve was 39.1 +/- 4.5 degrees at the aortic position and 44.6 +/- 9.7 degrees at the mitral position. Omnicarbon valves implanted in ninety-five patients, fifty-eight of these patients underwent AVR, 24 had MVR and 13 had DVR. Events occurred post-operatively in four (2.6%/patient year) of the AVR group, in three (12.2%/patient year) of the MVR group, but in none of the DVR group. The freedom at five years was 89 +/- 6% in the AVR and 84 +/- 8% at three years in the MVR. Post-operative cardiac death occurred in one (0.7%/patient year) of the AVR and in two (8.1%/patient year) of the MVR.(ABSTRACT TRUNCATED AT 250 WORDS)     

Single-center experience with the bicarbon bileaflet prosthetic heart valve in Japan

We analyzed midterm results using the Bicarbon valve in a single center. Forty-four patients had aortic valve replacement (AVR), 48 had mitral valve replacement (MVR), and 13 had both aortic and mitral valve replacement (DVR). The mean age of the 105 patients was 61.2 +/- 11.3 years. The mean follow-up was 1.8 +/- 1.1 years with a cumulative follow-up of 188 patient-years. There were 5 early deaths (4.7%: 4 in the AVR group and 1 in the MVR group) and 5 late deaths (2.7% per patient-year: 3 malignancy, 1 cerebral hemorrhage, 1 myocardial infarction). Survival at 3 years was 91 +/- 4% in the AVR group, 92 +/- 5% in the MVR group, and 66 +/- 23% in the DVR group. The linearized incidence of thromboembolic complications, hemorrhagic complications, and paravalvular leaks in all patients was 1.06 +/- 2.34%, 1.60 +/- 2.53%, and 0.53 +/- 2.22% per patient-year, respectively. No other complications were observed. In conclusion, the Bicarbon prosthetic heart valve has shown excellent clinical results associated with a low incidence of valve-related complications.     

Eight year experience with the CarboMedics bileaflet valvular prosthesis.

Two hundred and two patients (97 female and 105 male; mean age: 45. 5+/-9 years) received CarboMedics bileaflet valves during a period of eight years. Ninety-one patients received mitral, 72 aortic and 39 aortic+mitral valve prosthesis. Tricuspid plasty and coronary artery bypass surgery were the concomitant operations in 17 and 12 patients, respectively. The mean follow-up period was 24.7 months and the ratio was 91%. Overall operative mortality was 3.96% (8 patients); 2.78% for aortic valve replacement (AVR), 3.29% for mitral valve replacement (MVR) and 7.7% for double valve replacement (DVR). The late mortality rate was 2.89% for AVR, 2.2% for MVR and 8. 3% for DVR. The main cause of mortality was low cardiac output. The overall survival rate was 91.5% in 2 years. The actuarial freedom from thromboembolism in 2 years was 97% for AVR, 95% for MVR and 84% for DVR. No mortality due to heamorrhagic events was observed. CarboMedics prosthetic heart valves may be used satisfactorily with a low incidence of valve-related morbidity and mortality.     

Sorin Bicarbon bileaflet valve: a 10-year experience.

OBJECTIVE: To present a large 10 year experience of a collaborative evaluation of the Sorin Bicarbon (SB) mechanical prosthesis carried out in 14 centers in eight Western European countries. METHODS: Between 4/90 and 12/96, 2078 SB valves were implanted in 1875 patients aged 4-84 years (mean 58), 1108 males and 767 females. The valves inserted were 1026 aortic valve replacement (AVR), 656 mitral valve replacement (MVR) and 203 double valve replacement (DVR), additional procedures performed in 467 patients (282 coronary artery bypass grafting). RESULTS: Early mortality was 97 (5%), overall survival at 8 years was 71.8% AVR, 69.4% MVR, 81.4% DVR. Total late valve-related deaths were 55; overall freedom from valve-related death at 8 years was 95%. New York Heart Association (NYHA) status after surgery: 78% improved and 17% unchanged. Twenty-two valve thrombosis were observed, one fatal; overall freedom from thrombosis at 8 years was 98.5%. Embolism occurred in 95 patients, 77 cerebral events (16 deaths), overall freedom from embolism was 90.7% at 8 years. Six hemolytic events and 26 non-structural dysfunction (all periprosthetic leaks) were reported. Major bleeding occurred in 66, with mortality rate of 32% mainly when intracerebral. Overall freedom from bleeding was 90.8% at 8 years. Endocarditis occurred in 31 patients, 29% were fatal; overall freedom from endocarditis was 97.8% at 8 years. Reoperation was performed in 49 cases--periprosthetic leak 20, infective endocarditis 14, thrombosed valve 13 (and non-valve related-2). Mortality (early and late) occurred in three reoperated patients. CONCLUSIONS: This is a durable and effective mechanical valve substitute with low morbidity and mortality and good functional results.     

Heart valve operations in solid organ recipients: an 18-year single-center experience

BACKGROUND: We retrospectively analyzed the outcome of heart valve operations in solid organ recipients, who were referred for operation to our institution. METHODS: Over an 18-year period, 23 heart (group 1) and 16 renal (group 2) transplant recipients in New York Heart Association (NYHA) classes III and IV underwent valve operation. The mean interval from the time of transplantation to cardiac surgery was 77.9 months with a mean follow-up time of 34.6 months in group 1 and 87.2 months with a mean follow-up time of 39.2 months in group 2. RESULTS: Group 1 underwent tricuspid valve replacement (n=12), tricuspid valve reconstruction (n=7), aortic valve replacement (AVR, n=3), and mitral valve replacement (MVR, n=1). In group 2, mechanical valve replacement was performed in 14 patients (9 AVR, 3 MVR, 2 AVR and MVR) and tricuspid or mitral valve reconstruction in two patients. There was no operative death. During hospitalization, multiorgan failure due to sepsis was the main cause of mortality (2 in both groups). In the mean follow-up period of 41.2 months, there were four late non-cardiac-related deaths in group 1. Currently 29 surviving transplant recipients (16 heart, 69.6% and 13 renal, 81.3%) are in NYHA classes I and II. CONCLUSION: In heart and renal recipients, valve operations can be performed effectively and safely with acceptable mortality, low cardiac morbidity, and excellent clinical results, although infection is the most serious complication.     

三尖瓣置换术后早期及晚期疗效

目的　总结三尖瓣置换术后早期及晚期疗效 ,并分析与早期病死率可能有关的危险因素。方法　行三尖瓣置换术 2 3例病人中男 11例 ,女 12例 ;年龄 12～ 5 6岁 ,平均 2 7岁。其中三尖瓣下移畸形17例、先天性三尖瓣发育不全 3例、风湿性病变 2例、感染性心内膜炎 1例。术前心功能II级 3例、III级13例 ,IV级 7例。结果　本组死亡 3例 ,早期病死率 13%。平均随访时间 80个月 (5～ 130个月 ) ,随访率95 %。晚期死亡 1例 (5 2 % )。1例于术后 86个月时因生物瓣失功再次行三尖瓣置换 ;1例右房血栓。术后生存者心功能I～II级 15例 ,III级 3例。多因素分析显示 ,心功能IV级 (P =0 0 2 )、严重腹水 (P =0 0 0 1)及置换机械瓣 (P =0 0 13)与术后早期病死率有显著相关。结论　三尖瓣置换术后早期及晚期效果良好。术前心功能IV级、严重腹水以及置换机械瓣对术后早期病死率有明显影响