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替换术后远期疗效及其影响因素。方法:我院1980年-2004年施行心脏瓣膜替换613例,早期死亡30例。术后获访495例,获访时间为2700病人年, 平均5．45病人年。结果:晚期死亡37例。晚期死亡率1．61％病人年。机械瓣和生物瓣晚期死亡率分别为1．10％和6．10％病人年,15 年生存率分别为89．3％和43．1％。结论:影响心脏瓣膜替换晚期疗效主要因素为抗凝不当、术前心功能、年龄和心房颤动。机械瓣替换术晚期死亡原因主要为抗凝有关并发症、心室颤动、细菌性心内膜炎和心力衰竭,而生物瓣膜替换术晚期死亡原因则为生物瓣衰败。

Analysis of Long-Time Efficacy Valve Replacement for Rheumatic Heart Disease

Objective:To analyze late effect and factors influencing late effect after valve replacement for rheumatic heart disease. Methods:From January 1980 to December2004,valve replacement were performed in613 patients with rheumatic heart disease. There was 30 early deaths 495 were followed-up for,2700 patient-years, with the mean follow-up time was 5. 45%patient-years. Results: There were 37 late deaths,with the death rate of 1.40% (patient-years). The 15-year actual survival rates were 89. 3% and 43. 1% ,and the late death rates were 1. 10% and 6. 1% (patient-years)for mechanical and bioprosthetic valves,respectively. Conclusion:Factors influencing late effect were anticoagulatin-related complications, preoperative cardiac function, age and arterial fibrillation. Late death for mechanical valve replacement were associated with anticoagulation-related copmlications, ventricular arrhythmias,bacterial endocarditis and cardiac failure,but for bioprosthetic valves were due to wear-out failure.