Antretter H, Bonatti J, Mair P, Profanter C, Trieb K, Dapunt O E
Abteilung für Herzchirurgie der I. Universitätsklinik für Chirurgie, Innsbruck.
Wien Med Wochenschr. 1995;145(6):147-50.
In agreement with our experiences from our first study 15 patients (8 men, 7 women) underwent reoperation because of degeneration of bioprosthetic valves implanted in aortic or mitral position during the last 24 months. At reoperation 4 patients had a more complex cardiac procedure (double valve replacement, double valve replacement with bypass grafting, valve replacement with enlargement of the valvular area). There was no acute operation and only 1 patient was serious symptomatic preoperatively (NYHA IV). We revealed a mean implantation time of 126.4 months +/- 32.2 (median 130) for all bioprostheses without a significant difference in implant time regarding to aortic or mitral position. At reoperation bypass time (p = 0.001) and aortic clamp time (p = 0.011) was significantly longer compared to the first operation. There was no perioperative death, all patients are still alive and in good condition (8 of them NYHA I, 7 NYHA II). The early change of tissue degenerated bioprostheses can be carried out under elective conditions with improved postoperative outcome: mortality and morbidity remains acceptable low. In our group incremental risk factors for early mortality are severely affected patients with low functional status (NYHA IV) and acute operation. Preoperative coronary angiography remains essential for evaluation of concomitant coronary artery disease.
与我们第一项研究的经验一致，在过去24个月中，15例患者（8名男性，7名女性）因植入主动脉或二尖瓣位置的生物瓣膜退变而接受再次手术。再次手术时，4例患者接受了更复杂的心脏手术（双瓣膜置换、带旁路移植的双瓣膜置换、瓣膜置换并扩大瓣膜面积）。没有急诊手术，术前只有1例患者症状严重（纽约心脏协会心功能分级IV级）。我们发现所有生物瓣膜的平均植入时间为126.4个月±32.2（中位数130），主动脉或二尖瓣位置的植入时间无显著差异。再次手术时，与首次手术相比，旁路时间（p = 0.001）和主动脉阻断时间（p = 0.011）显著延长。没有围手术期死亡，所有患者仍存活且状况良好（其中8例纽约心脏协会心功能分级I级，7例II级）。组织退变生物瓣膜的早期更换可在择期条件下进行，术后结果得到改善：死亡率和发病率仍可接受地低。在我们的研究组中，早期死亡的增加风险因素是功能状态差（纽约心脏协会心功能分级IV级）的重症患者和急诊手术。术前冠状动脉造影对于评估合并的冠状动脉疾病仍然至关重要。
