Sener E, Yamak B, Katircioğlu S F, Ozerdem G, Karagöz H, Taşdemir O, Bayazit K
Department of Cardiovascular Surgery, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
Thorac Cardiovasc Surg. 1995 Jun;43(3):148-52. doi: 10.1055/s-2007-1013789.
From January 1984 to December 1993 a total of 154 patients (89 men and 85 women) required 160 reoperations for prosthetic heart valve dysfunction. Four patients required a second, two patients a third reoperation. Age was (mean +/- SD [range]) 38.8 +/- 10.2 (17 to 64) years. The primary operation was mitral valve replacement in 105 patients, aortic valve replacement in 20, and both aortic and mitral valve replacement in 29. The time interval between initial valve replacement and reoperation was 66.4 +/- 40 (3 to 288) months for the mechanical prostheses and 68.7 +/- 32 (24 to 140) months for bioprostheses; the difference was not statistically significant. Primary tissue failure was the most common cause of the reoperation for bioprostheses and valve thrombosis for mechanical prostheses. The hospital mortality rate was significantly higher in the replacement of mechanical prostheses (14/58 = 24.1% vs. 7/102 = 6.8%, p = 0.004). Low preoperative functional capacity and valve thrombosis were linked to higher mortality rates. It is discussed that monoleaflet mechanical valves yielded the highest operative mortality and that, excluding these, the risk of mortality in prosthetic valve reoperations today does not differ much from that in primary valve replacements.
1984年1月至1993年12月，共有154例患者（89例男性和85例女性）因人工心脏瓣膜功能障碍接受了160次再次手术。4例患者需要进行第二次再次手术，2例患者需要进行第三次再次手术。年龄为（均值±标准差[范围]）38.8±10.2（17至64）岁。初次手术中，105例患者进行了二尖瓣置换，20例进行了主动脉瓣置换，29例进行了主动脉瓣和二尖瓣联合置换。机械瓣膜初次置换与再次手术的时间间隔为66.4±40（3至288）个月，生物瓣膜为68.7±32（24至140）个月；差异无统计学意义。生物瓣膜再次手术最常见的原因是原发性组织衰竭，机械瓣膜则是瓣膜血栓形成。机械瓣膜置换的医院死亡率显著更高（14/58 = 24.1% 对比 7/102 = 6.8%，p = 0.004）。术前功能状态差和瓣膜血栓形成与较高的死亡率相关。讨论了单叶机械瓣膜的手术死亡率最高，且排除这些情况后，如今人工瓣膜再次手术的死亡风险与初次瓣膜置换的风险相比差异不大。
