主动脉瓣重度狭窄171例外科治疗分析

目的 总结主动脉瓣重度狭窄行瓣膜置换术患者的外科治疗经验.方法 1990年12月至2006年12月共有171例主动脉瓣重度狭窄患者接受主动脉瓣置换术.其中男性135例,女性36例;年龄10-75岁,平均(45.8±15.6)岁;病程2个月-52年.主动脉瓣病变的病因依次为风湿性75例、老年性66例、二叶瓣畸形26例及其他先天性主动脉瓣畸形4例.单独主动脉瓣置换124例,主动脉瓣置换+升主动脉置换7例,主动脉瓣置换+冠状动脉旁路移植5例,主动脉瓣置换+二尖瓣成形19例,主动脉瓣置换+升主动脉成形8例,主动脉瓣置换+主动脉根部拓宽8例(Nicks法).结果 全组患者平均手术时间(4.4±0.6)h,心肺转流时间(124.7±38.5)min,其中主动脉阻断时间(78.3±21.7)min,术中平均出血量(754.5±518.4)ml,所有患者均顺利完成手术并脱离心肺转流.术后早期并发症发生率为12.3%(21/171),包括低心排血量综合征7例,多脏器功能衰竭3例,心内膜炎1例,肾功能不全4例,心室颤动1例,开胸止血2例,Ⅲ度房室传导阻滞2例,纵隔感染1例.全组手术死亡率5.8%(10/171),死于心力衰竭4例,心律失常1例,多脏器功能衰竭4例,感染性心内膜炎1例.结论 主动脉瓣重度狭窄患者的外科治疗对手术技术及围手术期处理经验要求较高,积极行瓣膜置换手术效果满意.

Experiences on surgical treatment of severe aortic valve stenosis:a report of 171 cases

Objective To analyze the experiences on surgical treatment of severe aortic valve stenosis.Methods From December 1990 to December 2006, 171 patients with severe aortic valve stenosis underwent aortic valve replacement (AVR).There were 135 males and 36 females aged from 10 to 75 years old, with a mean of (45.8 ± 15.6) years old.The intervals between the first episode of exertion dyspnea and administration to operation were 2 months to 52 years.The pathological lesions of the group were rheumatic aortic valve stenosis in 75 cases, calcified aortic stenosis in 66 cases, bicuspid aorlic valve in 26 eases and other congenital aortic valve stenosis in 4 cases.One hundred and twenty-four patients underwent AVR, 7 AVR combined with replacement of the ascending aorta, 5 AVR with coronary artery bypass grafting, 19 AVR with mitral valve plasty (MVP), 8 AVR with plasty of the ascending aorta and 8 AVR with enlargement of the aortic root.Results The averaged operation time was (4.4 ± 0.6 ) h.Cardiopulmonary bypass (CPB) time was (124.7±38.5)min and the aorta clamp time was (78.3±21.7)rain.The averaged blood loss during operation was (754.5±518.4 ) ml.All the procedures were successfully performed and all patients were weaned off CPB uneventfully. The indication of early complications was 12.3% (21/171), including low cardiac output syndrome in 7 cases, multi-organ failure in 3 cases, endocarditis in 1 case, renal dysfunction in 4 cases, ventricular fibrillation in 1 case, excessive bleeding in 2 cases, Ⅲ atrial-ventricular block in 2 cases, and mediastinal infection in 1 case.The total mortality was 5.8% ( 10/171 ) with the main causes as cardiac failure for 4 cases, arrhythmia for 1 case,multi-organ failure for 4 cases, and infectious endocarditis for 1 case.Conclusions Successful management of severe aortic valve stenosis requires sophisticated surgical techniques and experienced peri-operative care.Satisfactory results can be achieved if valve replace surgery is performed adequately.