Pansini S, Ottino G, Forsennati P G, Serpieri G, Zattera G, Casabona R, di Summa M, Villani M, Poletti G A, Morea M
Department of Cardiac Surgery, University of Torino, Italy.
Ann Thorac Surg. 1990 Oct;50(4):590-6. doi: 10.1016/0003-4975(90)90195-c.
To evaluate risks and complications of reoperations on heart valve prostheses, we reviewed data on 183 patients who underwent reoperation because of prosthetic valve malfunction. The incremental effect of the redo procedure on hospital mortality and morbidity was studied by comparing primary and reoperative procedures and analyzing a series of possible predisposing factors. Late survival after first and second reoperations was computed, and possible determinants of late mortality were examined. Overall operative mortality was 8.7%; emergency operation (p = 0.0001), previous thromboembolism (p = 0.05), and advanced New York Heart Association functional class (p = 0.031) were the independent determinants. In a series of 1,355 patients having primary or secondary isolated valve replacement, the redo procedure was a significant risk factor in the univariate analysis (p = 0.025) but not in the multivariate analysis except for the subset of patients having mitral valve replacement (p = 0.052). The postoperative course was quite complicated, as evidenced by the long mean stay in the intensive care unit (mean stay, 3.8 days; longer than 2 days for 26% of the survivors). Nevertheless, postoperative complications were not significantly greater after a redo procedure than after a primary operation. Actuarial survival at 7 years was 57.3% +/- 8%. A comparison with a nonhomogeneous series from our institution did not demonstrate significant differences. In the subset of 16 patients having a second reoperation, late survival was 37.8% +/- 16% at 2 years. Advanced New York Heart Association class (p = 0.0001), double prosthetic valve dysfunction (p = 0.003), and any indication other than primary tissue failure (p = 0.06) were determinants of late mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估心脏瓣膜置换术后再次手术的风险及并发症，我们回顾了183例因人工瓣膜功能障碍而接受再次手术患者的数据。通过比较初次手术和再次手术过程，并分析一系列可能的诱发因素，研究再次手术对医院死亡率和发病率的增量影响。计算首次和第二次再次手术后的晚期生存率，并检查晚期死亡的可能决定因素。总体手术死亡率为8.7%；急诊手术（p = 0.0001）、既往血栓栓塞（p = 0.05）和纽约心脏协会心功能分级晚期（p = 0.031）是独立决定因素。在1355例接受初次或二次单纯瓣膜置换术的患者中，再次手术在单因素分析中是一个显著的危险因素（p = 0.025），但在多因素分析中并非如此，二尖瓣置换术患者亚组除外（p = 0.052）。术后病程相当复杂，重症监护病房的平均住院时间较长（平均住院时间3.8天；26%的幸存者超过2天）即可证明。然而，再次手术后的术后并发症并不比初次手术后显著增加。7年时的精算生存率为57.3%±8%。与本院一组非同质病例的比较未显示出显著差异。在16例接受第二次再次手术的患者亚组中，2年时的晚期生存率为37.8%±16%。纽约心脏协会心功能分级晚期（p = 0.0001）、双人工瓣膜功能障碍（p = 0.003）以及除原发性组织衰竭以外的任何指征（p = 0.06）是晚期死亡的决定因素。（摘要截选至250字）
