Cui Yong, Lu Fang-lin, Xu Zhi-yun, Zou Liang-jian, Wang Er-song, Wang Zhi-nong, Zhang Bao-ren
Department of Cardiothoracic Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China.
Zhonghua Wai Ke Za Zhi. 2008 Sep 1;46(17):1322-4.
To analyze the experiences on surgical treatment of severe aortic valve stenosis.
From December 1990 to December 2006, 171 patients with severe aortic valve stenosis underwent aortic valve replacement (AVR). There were 135 males and 36 females aged from 10 to 75 years old, with a mean of (45.8 +/- 15.6) years old. The intervals between the first episode of exertion dyspnea and administration to operation were 2 months to 52 years. The pathological lesions of the group were rheumatic aortic valve stenosis in 75 cases, calcified aortic stenosis in 66 cases, bicuspid aortic valve in 26 cases and other congenital aortic valve stenosis in 4 cases. One hundred and twenty-four patients underwent AVR, 7 AVR combined with replacement of the ascending aorta, 5 AVR with coronary artery bypass grafting, 19 AVR with mitral valve plasty (MVP), 8 AVR with plasty of the ascending aorta and 8 AVR with enlargement of the aortic root.
The averaged operation time was (4.4 +/- 0.6) h. Cardiopulmonary bypass (CPB) time was (124.7 +/- 38.5) min and the aorta clamp time was (78.3 +/- 21.7) min. The averaged blood loss during operation was (754.5 +/- 518.4) ml. All the procedures were successfully performed and all patients were weaned off CPB uneventfully. The indication of early complications was 12.3% (21/171), including low cardiac output syndrome in 7 cases, multi-organ failure in 3 cases, endocarditis in 1 case, renal dysfunction in 4 cases, ventricular fibrillation in 1 case, excessive bleeding in 2 cases, III atrial-ventricular block in 2 cases, and mediastinal infection in 1 case. The total mortality was 5.8% (10/171) with the main causes as cardiac failure for 4 cases, arrhythmia for 1 case, multi-organ failure for 4 cases, and infectious endocarditis for 1 case.
Successful management of severe aortic valve stenosis requires sophisticated surgical techniques and experienced peri-operative care. Satisfactory results can be achieved if valve replace surgery is performed adequately.
分析重度主动脉瓣狭窄的外科治疗经验。
1990年12月至2006年12月，171例重度主动脉瓣狭窄患者接受了主动脉瓣置换术（AVR）。其中男性135例，女性36例，年龄10至75岁，平均（45.8±15.6）岁。首次出现劳力性呼吸困难至手术的间隔时间为2个月至52年。该组病理病变中，风湿性主动脉瓣狭窄75例，钙化性主动脉瓣狭窄66例，二叶式主动脉瓣26例，其他先天性主动脉瓣狭窄4例。124例行AVR，7例行AVR联合升主动脉置换，5例行AVR联合冠状动脉搭桥术，19例行AVR联合二尖瓣成形术（MVP），8例行AVR联合升主动脉成形术，8例行AVR联合主动脉根部扩大术。
平均手术时间为（4.4±0.6）小时。体外循环（CPB）时间为（124.7±38.5）分钟，主动脉阻断时间为（78.3±21.7）分钟。术中平均失血量为（754.5±518.4）毫升。所有手术均成功完成，所有患者均顺利脱离CPB。早期并发症发生率为12.3%（21/171），包括低心排综合征7例，多器官功能衰竭3例，心内膜炎1例，肾功能不全4例，心室颤动1例，出血过多2例，Ⅲ度房室传导阻滞2例，纵隔感染1例。总死亡率为5.8%（10/171），主要原因为心力衰竭4例，心律失常1例，多器官功能衰竭4例，感染性心内膜炎1例。
重度主动脉瓣狭窄的成功治疗需要精湛的手术技术和经验丰富的围手术期护理。如果瓣膜置换手术操作得当，可取得满意效果。
