再次瓣膜替换术64例报告

作者报告１９８８年２月至１９９６年５月间，行再次瓣膜替换术病例６４例，其中生物瓣衰坏４６例，机械瓣功能障碍９例，瓣周漏９例。按照术前的心功能状态，９例因机械瓣急性功能障碍，引起急性充血性心力衰竭或心源性休克，施行急症手术，其余５５例行择期手术。早期死亡８例（１２．５０％），其中择期手术后死亡３例（５．５０％），急症手术后死亡３例（３３．３％）。长期生存者５６例，随访时间３个月至７年（平均２．１年），晚期死亡３例（５．３％）。生存１年以上的４８例中，心功能恢复至Ⅰ级者４２例，Ⅱ级５例，Ⅲ级１例。作者对再次瓣膜替换术的手术时机与手术操作的重点作了讨论。

Reoperations on prosthetic heart valves:an analysis of 64 cases

During the period of Fabruary 1988 to May 1996, 64 reoperations were performed for prosthetic valve malfunction. Degeneration of bioprosthesis occurred in 46 patients, failure of mechanical prosthesis in 9, and periprosthetic leakage without evidence of infection in 9. In accordance with the status of cardiac function, 9 patients with acute dysfunction of mechanical prosthesis received emergency operations, and the remaining 55 patients with bioprosthetic valve failure or periprosthetic leakage received selective operation. There were 8 early deaths with a overall hsopital mortality rate of 12.5%. Three of the deaths occurred among the 55 selective procedures for a mortality of 5.3% and 3 of the deaths occurred among the 9 emergence procedures for mortality of 33.3%. The 56 long-term survivors were followed up from 3 months to 7 years (mean 2.1 years). There were 3 late deaths (5.3%). Forty-eight patients have been living more than 1 year. Their cardiac function after reoperation was class I (42 patients), class II (5), and class III (1). The timing of reoperation and surgical technique were discussed.