Caus T, Mesana T, Mouly A, Guez P, Tapia M, Montiès J R
Service de chirurgie cardiaque, CHU La Timone-adultes, Marseille.
Arch Mal Coeur Vaiss. 1995 Jan;88(1):35-41.
In order to determine the prognosis of reoperation for valvular replacement, we reviewed the results of a consecutive series of 124 patients operated in the department between 1974 and 1992 (163 multi redo operations). There were 69 women and 55 men, with a mean age 48 years; 77% of the patients were in functional class III or IV. Operations were performed as an emergency in 30% of cases. Endocarditis was found in 24% of cases and was an important risk factor in this content. The main indications for reoperation were periprosthetic leakage in 28.8% of cases and failure of bioprostheses in 23.7%. The valvular replacement was simple in 61%, double in 32% and triple in 7% of cases. An associated procedure was necessary in 27% of cases. Mechanical devices were implanted in 62.3% of cases. Peroperative mortality was 3% and hospital mortality, mainly from cardiac causes, was 21.7% for the second, 20% for the third and 55.6% for the fourth reoperations. Operative mortality was dependent on the number or reoperations, functional class, emergency surgery, duration of bypass and cross-clamping time. Four per cent of patients were lost to follow-up and 30 patients died secondarily. The actuarial survival rate was 52% at 5 years and 33% at 10 years, actuarial survival rate without valvular complication was 41% at 5 years and 19% at 10 years but the functional results remained good with over 90% of patients in functional class I or II at the end of follow-up.
为了确定瓣膜置换再次手术的预后，我们回顾了1974年至1992年间在本科室连续进行手术的124例患者（163次多次再次手术）的结果。其中女性69例，男性55例，平均年龄48岁；77%的患者为心功能Ⅲ级或Ⅳ级。30%的病例为急诊手术。24%的病例发现有感染性心内膜炎，在此情况下这是一个重要的危险因素。再次手术的主要指征是人工瓣膜周漏占28.8%的病例，生物瓣膜功能障碍占23.7%。61%的病例为单纯瓣膜置换，32%为双瓣膜置换，7%为三瓣膜置换。27%的病例需要联合手术。62.3%的病例植入了机械瓣膜。围手术期死亡率为3%，住院死亡率主要由心脏原因导致，第二次再次手术为21.7%，第三次为20%，第四次为55.6%。手术死亡率取决于再次手术次数、心功能分级、急诊手术、体外循环时间和主动脉阻断时间。4%的患者失访，30例患者继发死亡。5年的精算生存率为52%，10年为33%，无瓣膜并发症的精算生存率5年为41%，10年为19%，但功能结果仍然良好，随访结束时超过90%的患者为心功能Ⅰ级或Ⅱ级。
