摘要
目的总结118例再次瓣膜置换手术治疗的方法及体会。方法回顾性分析118例经超声心动图明确诊断需再次行瓣膜置换手术患者的临床资料,其中二尖瓣和主动脉瓣置换12例,主动脉瓣置换31例,二尖瓣置换70例,三尖瓣置换5例。再次瓣膜置换手术原因:机械瓣失功62例,瓣周漏27例,生物瓣衰败26例,生物瓣功能障碍3例。结果围术期死亡8例,死亡率为6. 8%,死亡原因为多器官功能衰竭、恶性心律失常、严重低心排血量综合征。术后发生并发症19例,发生率为16. 1%。结论相对于首次瓣膜手术,再次瓣膜置换手术的操作难度大、出血多,术后并发症发生率及死亡率高。再次瓣膜手术的主要原因为机械瓣失功、瓣周漏及生物瓣衰败等。
Objective To summarize the approaches and experience of 118 cases of re-valve replacement surgery.Methods The clinical data of 118 patients requiring re-valve replacement surgery after definitive diagnosis confirmed by echocardiography were analyzed retrospectively,including12 cases of mitral and aortic valve replacement,31 cases of aortic valve replacement,70 cases of mitral valve replacement,and 5 cases of tricuspid valve replacement.The causes of re-valve replacement surgery were as follows:mechanical valve failure in 62 cases,perivalvular leakage in 27 cases,bioprosthetic valve failure in 26 cases,and bioprosthetic valve dysfunction in 3 cases.Results Eight cases died during the perioperative period,with a mortality of 6.8%.The causes of death were multiple organ failure,malignant arrhythmia,and severe low cardiac output syndrome.Postoperative complications occurred in 19 cases,with an incidence rate of 16.1%.Conclusion Compared with the first valve operation,re-valve replacement surgery has great difficulty in operation,heavy blood loss,and high incidence rate of postoperative complications and mortality.The major causes of re-valve surgery are mechanical valve failure,perivalvular leakage,and bioprosthetic failure.
引文
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