Livi U, Bortolotti U, Rizzoli G, Valfré C, Mazzucco A, Gallucci V
Thorac Cardiovasc Surg. 1982 Oct;30(5):288-91. doi: 10.1055/s-2007-1022408.
During a 10-year period (1972 to 1981), 48 patients underwent repair of combined aortic, mitral and tricuspid disease at our Institution. The aortic valve was replaced in 47 cases and treated by valvulotomy in one; the mitral valve was replaced in 47, and conservatively managed in one by means of open mitral commissurotomy; the tricuspid valve was treated by annuloplasty in 37, by commissurotomy in 3 and replaced in 8. Operative mortality decreased from 67% among those cases operated on normothermic cardiopulmonary bypass (CPB) with coronary artery perfusion (1972 to 1973) to 23% in those operated with mild hypothermic CPB and intermittent aortic cross-clamping (1974 to 1976), to 8% in patients treated with mild to deep hypothermic CPB and cold cardioplegic solutions (1977 to 1981) (p = 0.012). Analysis of the factors affecting the surgical risk has demonstrated that age at the time of operation, preoperative functional class, duration of the disease, preoperative cardiothoracic ratio and insertion of a prosthesis in the tricuspid position did not significantly influence the operative result. On the contrary, the recent techniques of myocardial protection with the use of cold cardioplegia, possibly associated with an earlier indication for operation and a prompter treatment of postoperative complications, were the major determinants of the improved surgical outcome.
在10年期间（1972年至1981年），我院有48例患者接受了主动脉、二尖瓣和三尖瓣联合疾病的修复手术。47例患者进行了主动脉瓣置换，1例进行了瓣膜切开术；47例患者进行了二尖瓣置换，1例通过开放式二尖瓣交界切开术进行了保守治疗；37例三尖瓣患者接受了瓣环成形术，3例接受了交界切开术，8例进行了瓣膜置换。手术死亡率从在常温体外循环（CPB）下进行冠状动脉灌注的手术患者中的67%（1972年至1973年），降至轻度低温CPB和间歇性主动脉交叉钳夹手术患者中的23%（1974年至1976年），再降至轻度至深度低温CPB和冷心脏停搏液治疗患者中的8%（1977年至1981年）（p = 0.012）。对影响手术风险因素的分析表明，手术时的年龄、术前功能分级、疾病持续时间、术前心胸比率以及三尖瓣位置植入假体均未对手术结果产生显著影响。相反，使用冷心脏停搏液的近期心肌保护技术，可能与更早的手术指征和术后并发症的更及时治疗相关，是手术结果改善的主要决定因素。
