249例重症心脏瓣膜病做人工瓣膜置换的体会

目的：总结重症心脏瓣膜病的外科治疗效果的围术期处理方法。方法：回顾性分析本院249例重症瓣膜病手术病人,其中二尖瓣置换（MVR）129例,主动脉瓣置换（AVR）39例,MVR＋AVR 81例;同期行三尖瓣成形（TVP）152例,左房折叠术12例,冠状动脉旁路移植术（CABG）18例。结果：手术早期死亡8例,死亡率3.2%（8/249）。在241例中,随访235例,随访率为97.5%,随访时间6个月至5.5年,死亡2例,随访病死率.8%（2/235）,其余232例术后随诊复查人工瓣膜功能良好,左心射血分数提高,心功能均提高1-2级,无瓣周漏、人工瓣膜心内膜炎及心脏血栓形成,没有因瓣膜原因而再次手术的。结论：对外科治疗重症心脏瓣膜病的围术期处理,术前注重改善心功能,选择合适的手术时机,尽量保留瓣下结构,选择合适的瓣膜,同时处理三尖瓣病变和巨大左房,采用含血停跳液温冷温顺序灌注,加强术后处理,可提高重症心脏瓣膜病的外科治疗效果。

Experience with Prosthetic Replacement in 249 Cases of Severe Heart Valve Diseases

Objective：To summarize the experience of perioperative treatment to improve surgical outcomes in severe heart valve diseases. Methods： 249 surgical cases of severe heart valve diseases in our hospital were retrospectively analyzed, including 129 cases of mitral valve replacement （MVR）, 39 of aortic valve replacement （AVR） , 81 of double valves replacement （MVR ＋ AVR）. In some of the patients, contemporary operations were performed, including 152 cases of tricuspid valvuloplasty （TVP）, 12 of left atrial wall placation and 18 of coronary artery bypass graft （CABG）. Results： 8 eases died early after operation（fatality rate3.2% ）. 235 eases were follow up ranged from 6 months to 5.5 years,and among them , 2 eases died （fatality rate 0.8% ） , the others had good heart valve prosthesis tunctiou, higher left ventricular ejection fraction and improved heart function classified as grade Ⅰ or Ⅱ （NYHA classification）. There were no periprosthetic leakage ,prosthetic valve endocarditis and thrombosis. Nobody need reoperation because of prosthetic valve reasons. Conclusion： Perioperative treatment of severe heart valve disease should focus on improvement of pre-surgical heart function, proper timing of surgical procedure, reservation of subvalvular structure as much as possible, selection of artificial valves, coneun＇ent management of disordered tricuspid valve and giant left atrium, use of warn〉cold-warm perfusion sequence by sanguineous eardioplegic solution and enhanced postoperative management. These measures can be expected to improve the surgical outcomes of severe heart valve diseases.