Clinical Outcome of Reoperation for Mechanical Prosthesis at Aortic Position
Clinical Outcome of Reoperation for Mechanical Prosthesis at Aortic Position
复制标题
主动脉位置机械假体再手术的临床结果
DOI：
10.1016/j.hlc.2021.01.002
复制
发表时间：
2021-06-01
影响因子：
2.6
通讯作者：
Zhang, Guanxin
中科院分区：
文献类型：
--
作者：
Li, Ning;Peng, Jianhui;Zhang, Guanxin
目的重做主动脉瓣手术通常具有较高的死亡率和并发症风险。方法对2003~2019年间146例主动脉位置再次手术患者的临床资料进行分析。结果平均年龄51.5±12.7岁，女性69例(47.3%)。从前次手术到再次行主动脉瓣膜手术的中位间隔时间为6年。病因：血管疙瘩合并主动脉瓣狭窄62例(42.5%)，人工瓣膜心内膜炎(PVE)5例(3.4%)，PVE合并瓣膜周围漏(PVL)16例(11.0%)，PVL 45例(30.8%)，血栓形成7例(4.8%)，主动脉病变11例(7.5%)。手术方式：主动脉瓣置换术81例(55.5%)，Bentall术34例(23.3%)，PVL修补术6例(4.1%)，血管膜清理术25例(17.1%)。14(14)例(9.6%)患者围手术期死亡。多因素分析显示，机械通气时间延长和术后肾功能衰竭是死亡率的显著独立预测因素。5年和10年生存率分别为87.8%+/-7.4%和76.4%+/-15.1%。5年和10年生存率分别为87.7%+/-13.7%和84.2%+/-15.6%，而无血管圈组分别为84.5%+/-12.6%和74.6%+/-19.4%(p=0.951)。5年和10年存活率分别为87.5%+/-14.2%和75.8%+/-22.7%，84.7%+/-11.9%和81.6%+/-13.5%(p=0.365)。重做主动脉瓣手术效果满意，但并发症风险较高。患者的长期生存似乎与病因无关。重做主动脉瓣手术的最终决定应以病因学为基础。
Aim Redo aortic valve surgery is usually associated with a high risk of mortality and complications. The aim of this study was to investigate the perioperative and long-term outcomes of reoperation after prior me-chanical prosthesis implantation at the aortic position.Method The clinical data of 146 consecutive patients who underwent reoperation at the aortic position between 2003 and 2019 were analysed.Results Mean age was 51.5 +/- 12.7 years and 69 (47.3%) were female. The median interval from prior surgery to redo aortic valve surgery was 6 years. The aetiologies were pannus formation with prosthetic aortic stenosis in 62 cases (42.5%), prosthetic valve endocarditis (PVE) in five (3.4%), PVE with perivalvular leakage (PVL) in 16 (11.0%), PVL in 45 (30.8%), thrombosis in seven (4.8%), and aortic disease in 11 (7.5%). As for surgical procedure, aortic valve replacement was performed in 81 cases (55.5%), Bentall in 34 (23.3%), PVL repair in six (4.1%), and pannus debridement in 25 (17.1%). Fourteen (14) (9.6%) patients expired perioperatively. Prolonged ventilation time and postoperative renal failure were proved to be significant independent predictors of mortality according to multivariate analysis. Overall survival was 87.8%+/- 7.4% and 76.4%+/- 15.1% at 5 and 10 years, respectively. Survival was 87.7%+/- 13.7% and 84.2%+/- 15.6% in the pannus group, and 84.5%+/- 12.6% and 74.6%+/- 19.4% in the non-pannus group at 5 and 10 years, respectively (p=0.951). Survival was 87.5%+/- 14.2% and 75.8%+/- 22.7% in the PVL group and 84.7%+/- 11.9% and 81.6%+/- 13.5% in the non-PVL group at 5 and 10 years, respectively (p=0.365).Conclusions Pannus formation and PVL are two major indications for reoperation of mechanical prosthesis at the aortic position. Redo aortic valve surgery has a satisfactory outcome but with a high risk of complications. Long -term survival of patients seems not to be related to the aetiology. Final decision-making of redo aortic valve surgery should be based on aetiology.