Otaki M, Kitamura N
Division of Cardiovascular Surgery, Osaka National Hospital, Japan.
Artif Organs. 1993 Sep;17(9):791-6. doi: 10.1111/j.1525-1594.1993.tb00633.x.
To evaluate risks and complications of reoperations on prosthetic heart valves, we reviewed data on 70 patients who underwent reoperations because of prosthetic valve malfunction. Overall hospital mortality was 13% (9/70 patients). The common cause of death was low cardiac output syndrome following surgery (4 patients). Respiratory failure and mediastinal infection accounted for 2 deaths each, and neurological complication for 1 death. However, hospital mortality was different according to the risk factors; reoperations for prosthetic valve endocarditis (18%, p < 0.05), advanced New York Heart Association (NYHA) class (50%, p < 0.001), and emergency operation (33%, p < 0.005) were the significant risk factors. In contrast, advanced age, female sex, type of prosthesis, valve position, and diagnosis (leak, structural deterioration, or valve thrombosis) did not appear to be significant risk factors. There were 7 late deaths (4 valve-related, 2 cardiac, and 1 noncardiac). Inasmuch as emergency operation, advanced NYHA class, and prosthetic valve endocarditis affected hospital mortality, these factors contributed to late death. Actuarial survival rate and freedom from valve-related mortality at 10 years were 75.8 +/- 2.8% and 87.2 +/- 2.3%, respectively. There were 8 valve-related complications, and freedom from valve-related complications at 10 years was 73.5 +/- 3.5%. As judged by these data, hospital mortality and late survival can be improved if hemodynamic conditions leading to myocardial damage can be prevented.
为评估人工心脏瓣膜再次手术的风险和并发症，我们回顾了70例因人工瓣膜功能障碍接受再次手术患者的数据。总体医院死亡率为13%（9/70例患者）。常见死亡原因是术后低心排血量综合征（4例患者）。呼吸衰竭和纵隔感染各导致2例死亡，神经并发症导致1例死亡。然而，根据危险因素不同，医院死亡率有所差异；人工瓣膜心内膜炎再次手术（18%，p<0.05）、纽约心脏协会（NYHA）心功能分级晚期（50%，p<0.001）和急诊手术（33%，p<0.005）是显著危险因素。相比之下，高龄、女性、假体类型、瓣膜位置和诊断（渗漏、结构恶化或瓣膜血栓形成）似乎不是显著危险因素。有7例晚期死亡（4例与瓣膜相关，2例心脏原因，1例非心脏原因）。由于急诊手术、NYHA心功能分级晚期和人工瓣膜心内膜炎影响医院死亡率，这些因素导致了晚期死亡。10年的精算生存率和无瓣膜相关死亡率分别为75.8±2.8%和87.2±2.3%。有8例瓣膜相关并发症，10年无瓣膜相关并发症率为73.5±3.5%。根据这些数据判断，如果能预防导致心肌损伤的血流动力学状况，医院死亡率和晚期生存率可以得到改善。
