1566例联合瓣膜置换手术早期疗效分析

目的:分析1566例联合瓣膜病变外科治疗的早期疗效。方法:回顾性分析我院联合瓣膜置换术的早期临床资料,本组1566例,占同期瓣膜手术患者34.6%(1566/4526),瓣膜疾病的病因以风湿性心脏病为最常见,占96.3%。男/女比例为654/912,年龄(45.51±15.48)岁,病程(12.42±7.75)年,术前心功能等级(NYHA,级)为3.11±1.72。本组全部患者行联合瓣膜置换术,其中心脏停跳下手术1259例,心脏不停跳下手术307例,行二尖瓣置换+主动脉瓣置换手术1510例,二尖瓣置换+三尖瓣置换手术8例,二尖瓣置换+主动脉瓣置换手术+三尖瓣置换手术例48例;另外,本组同期行三尖瓣环缩成形术342例,左心房血栓清除173例,左心房折叠术87例,冠状动脉搭桥手术27例,主动脉根部加宽21例。结果:手术早期病死率(住院病死率)为1.40%(22/1566),其余均痊愈出院。其中低心输出量综合征(低心排)死亡8例,严重心律紊乱(主要指心室颤动、心脏骤停)4例,呼吸衰竭3例,多脏器功能衰竭4例,肾衰竭1例,脑部并发症1例,主动脉根部破裂1例。结论:联合瓣膜置换术的主要并发症为低心排、顽固性心律紊乱、呼吸衰竭、多脏器功能衰竭及肾衰竭等;手术早期疗效好,中、远期疗效有待进一步随访研究。

The early outcome analysis of combined valvular replacement in 1566 cases

Objective：To evaluate the efficacy of surgical treatment of 1 566 patients with combined heart valvular disease.Methods：Clinical data of 1 566 patients（male 654,female 912） underwent double heart valves replacement（DVR） between Jan 1996 and Dec 2009 were studied retrospectively.The age distribution was from 9 to 71 years with an average of（45.51 ± 15.48） years.The NYHA were 3.11 ± 1.72.The cold blood cardioplegia solution were used to protect the myocardium during operation in 1 259 cases,and onpump beating heart without using cardioplegia solution in 307.Procedures included mitral valve replacements（MVR） combined with aortic valve replacement（AVR） 1 510 cases,（MVR） combined with tricuspid valve replacement replacement（TVR） 8 cases,（MVR） combined AVR and TVR 48 cases.Concomitant procedures included tricuspid annuloplasty in 342 of patients,coronary bypass in 27 cases,root enlargement in 21 cases with small aortic annulus,clearance of left atrial thrombus in 173 cases,and placating of giant left atrium in 87 cases.Results：There were 22 early deaths（hospital deaths,1.40%,22 /1 566） due to low-output syndrome（n =8）,malignant ventricular arrhythmias（n =4）,multiple organ system failure（n =4）,respiratory failure（n =3）,renal failure（n =3）,brain damage（n = 1） and aortic root rupture（n = 1）.Conclusion：Our results show that the major complication included low-output syndrome,malignant ventricular arrhythmias,multiple organ system failure,respiratory failure,renal failure,and brain damage in the group painets.The early results of combined valvular replacement for patients with combined heart valvular disease were satisfactory.The midterm and long-term results of combined valvular replacement for patients with combined heart valvular disease need more researchs.