Houser S, Salomon J, Carias N, Hashmi F, Lehmann T, Chawla S
University of Connecticut School of Medicine, Farmington.
Conn Med. 1993 Nov;57(11):715-20.
Forty-nine consecutive repeat cardiac valve replacements in 46 patients were reviewed to define in-hospital morbidity, mortality, and determinants of risk. The overall operative mortality rate was 10.2%; it was 9% for the first reoperation and 25% for the second (four patients). The mortality rate was 12% at the mitral position (25 patients), 11% at the aortic position (18 patients), and 0% for repeat double valve replacement (four patients). Univariate and multivariate stepwise logistic regression models show that age over 70 years and the use of an intraaortic balloon pump preoperatively predict operative mortality, and age over 70, preoperative care in the coronary care unit, endocarditis, and the presence of an intraaortic balloon pump are determinants of perioperative morbidity in patients undergoing repeat valve replacement. Based on these data, close follow-up of patients with initial valve replacement is encouraged so that reoperation to correct prosthetic malfunction or periprosthetic leak can be done before hemodynamic collapse occurs. Furthermore, since age was the most significant factor affecting mortality (P < .01) and since most of the deaths (80%) in this study occurred in patients with torn bioprosthetic leaflets, the use of bioprostheses for initial valve replacement in patients under 70 years of age is discouraged.
回顾了46例患者连续进行的49次心脏瓣膜置换术，以确定住院期间的发病率、死亡率和风险决定因素。总体手术死亡率为10.2%；首次再次手术的死亡率为9%，第二次（4例患者）为25%。二尖瓣置换术（25例患者）的死亡率为12%，主动脉瓣置换术（18例患者）的死亡率为11%，再次双瓣膜置换术（4例患者）的死亡率为0%。单因素和多因素逐步逻辑回归模型显示，70岁以上年龄和术前使用主动脉内球囊反搏可预测手术死亡率，70岁以上年龄、术前在冠心病监护病房护理、心内膜炎以及存在主动脉内球囊反搏是再次瓣膜置换术患者围手术期发病的决定因素。基于这些数据，鼓励对初次瓣膜置换术患者进行密切随访，以便在血流动力学崩溃发生前进行再次手术以纠正人工瓣膜功能障碍或人工瓣膜周漏。此外，由于年龄是影响死亡率的最重要因素（P <.01），且本研究中大多数死亡（80%）发生在生物瓣膜小叶撕裂的患者中，因此不鼓励在70岁以下患者初次瓣膜置换时使用生物瓣膜。
