Ahmed Ahmed, Toema Ahmed, Yehia Ahmed, Hashim Yassin, Elkahely Mohamed, Onsy Ahmed
Cardiothoracic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Cardiothoracic Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt.
Heart Surg Forum. 2019 Nov 25;22(6):E452-E455. doi: 10.1532/hsf.2541.
Dilated left ventricle occurs in chronic aortic and mitral regurgitations. We describe the early outcome of mitral and aortic valve replacement for patients with severely dilated left ventricle in different surgical interventions.
From March 2014 to December 2018, 620 patients with left ventricular end-diastolic diameter (LVEDD) of ≥ 70 mm underwent valve replacement procedures in 8 cardiac surgery centers in Egypt. One hundred ninety four cases (31.3%) underwent aortic valve replacement, 173 cases (27.9%) underwent mitral valve replacement, 123 cases (19.9%) underwent double valve replacement, 59 cases (9.5%) underwent double valve replacement with either tricuspid valve repair or replacement, 33 cases (5.3%) underwent mitral valve replacement with either tricuspid valve repair or replacement, 20 cases (3.2%) underwent mitral valve replacement with CABG, 10 cases (1.6%) underwent aortic valve replacement with CABG, while 8 cases (1.3%) underwent aortic valve replacement with ascending aortic aneurysm repair.
Four patients (0.6%) developed new postoperative renal failure, which required dialysis. Twenty-nine patients (4.7%) required reoperation for bleeding. One patient (0.2 %) developed sternal dehiscence. Five patients (0.8%) postoperatively developed stroke. Twenty-five patients (4%) died, and the main causes of death were low cardiac output and sepsis with eventual multi-organ failure.
Valve replacement in patients with hugely dilated left ventricle are safe operations with satisfactory outcomes even if combined with other procedures, especially with proper preoperative preparation, intraoperative preservation of posterior mitral leaflet, and meticulous postoperative follow up in the surgical ICU.
左心室扩张见于慢性主动脉瓣和二尖瓣反流。我们描述了不同手术干预下严重扩张左心室患者行二尖瓣和主动脉瓣置换术的早期结果。
2014年3月至2018年12月，埃及8个心脏外科中心的620例左心室舒张末期直径（LVEDD）≥70mm的患者接受了瓣膜置换手术。194例（31.3%）接受主动脉瓣置换术，173例（27.9%）接受二尖瓣置换术，123例（19.9%）接受双瓣膜置换术，59例（9.5%）接受双瓣膜置换术并同期行三尖瓣修复或置换术，33例（5.3%）接受二尖瓣置换术并同期行三尖瓣修复或置换术，20例（3.2%）接受二尖瓣置换术并同期行冠状动脉旁路移植术（CABG），10例（1.6%）接受主动脉瓣置换术并同期行CABG，而8例（1.3%）接受主动脉瓣置换术并同期行升主动脉瘤修复术。
4例（0.6%）患者术后出现新发肾衰竭，需要透析治疗。29例（4.7%）患者因出血需要再次手术。1例（0.2%）患者发生胸骨裂开。5例（0.8%）患者术后发生卒中。25例（4%）患者死亡，主要死亡原因是低心排血量和脓毒症，最终导致多器官功能衰竭。
即使合并其他手术，尤其是经过适当的术前准备、术中保留二尖瓣后叶以及在外科重症监护病房进行细致的术后随访，对于左心室极度扩张的患者行瓣膜置换术仍是安全的手术，且预后良好。
