老年心脏瓣膜置换术

目的 观察首次和多次心脏手术的老年心脏瓣膜病施行瓣膜置换术的疗效。方法 从１９９４年８月到１９９８年８月，共对５７例老年患者（６０～７５岁）施行瓣膜置换术，包括１３例（２２．８％）二尖瓣行“闭式分离术”后再狭窄患者和６例（１０．５％）二尖瓣膜再狭窄行“双径闭式分离术”后再－再狭窄患者。结果 手术死亡４例（７．０１％）其中有１例再狭窄和２例再－再狭窄患者。随访３个月到４年，晚期死亡４例，３例（５．８

Heart valve replacement in the elderly patient

Objective To review over the heart valve replacement in the elderly patients, including those oper-ated secondarily and tertiarily. Methods From August 1994 to August 1998, 57 consecutive elderly cardiac patients(age 60 to 75 years, mean 65.8 years) were operated in our hospital. There were 38 mitral valve replacement, 7 aorticvalve replacement and 12 multiple valvular replacement, including 13 (22.8 % ) re-stenotic mitral valve after left-routeclosed mitral commissurotomy and 6 (10.5％) re-re-stenotic mitral valve after reoperative dual-route closed mitral com-missurotomy. Results Four patients (7.01％) died, including 1 re-stenotic and 2 re-re-stenotic patients. The follow-up period was 3 months to 4 years. There were 4 late deaths, 3(5.8％) related to heart failure and myocardial infarc-tion. Valve replacement related complications were thromboembolism in three (5.8％) cardiac failure, in two (3.9％)infective endocarditis and myocardial infarction in one (1.9％) each. 95.7％ of the survived patients were in NYHAfunction grade 1～2. Conclusions Valvular replacement surgery in the elderly can be performed safely and effectivelywith improved myocardial protection, intraoperative strategies and postoperative care. And for those re-and re-re-stenotic patients, the details of pulmonary and renal functions should be carefully evaluated preoperatively. (ShanghaiMed J, 2000,23:603-605)