摘要
目的评估Commando手术在机械瓣瓣膜功能障碍再次行瓣膜置换手术中的可行性及有效性。方法回顾性分析2021年12月—2022年9月于高州市人民医院心血管外科行Commando手术(主动脉瓣/二尖瓣幕帘扩大+瓣膜置换手术)患者的临床资料。选取既往行二尖瓣或主动脉瓣机械瓣置换术后机械瓣功能障碍,合并二尖瓣或主动脉瓣瓣膜病变,需要再次行联合瓣膜置换手术的患者。结果纳入患者11例,其中男2例、女9例,平均年龄(63.63±11.64)岁。所有患者均成功行Commando手术,置入合适型号的人工瓣膜,主动脉瓣膜尺寸为(27.00±2.00)mm,二尖瓣瓣膜尺寸为(27.72±3.13)mm。体外循环时间(195.81±39.29)min,主动脉阻断时间(121.81±28.60)min,机械通气时间(15.09±3.72)h,ICU停留时间(3.09±0.70)d,术后胸腔引流量(417.18±68.65)m L。全组无围手术期死亡。结论Commando手术在机械瓣瓣膜功能障碍再次行联合瓣膜手术中安全、有效,可以植入更大型号的人工瓣膜,获得良好的血流动力学效果。此外,对于高龄患者,可植入合适型号生物瓣膜,提高患者生活质量,早期手术效果满意,远期疗效有待进一步随访。
Objective To explore the feasibility and effectiveness of Commando procedure for mechanical valve dysfunction requiring reoperation.Methods The clinical data of patients who received Commando surgery(aortic/mitral curtain enlargement+valve replacement surgery)in the Department of Cardiovascular Surgery of Gaozhou People's Hospital from December 2021 to September 2022 were retrospectively analyzed.These patients who had undergone mechanical mitral or aortic valve replacement and then had mechanical valve dysfunction with mitral or aortic valve lesions requiring repeat combined valve replacement surgery were selected.Results Eleven patients were enrolled,including 2 males and 9 females,aged 63.63±11.64 years.All 11 patients successfully underwent the Commando operation,and were implanted with suitable artificial valves,among which the aortic valve size was 27.00±2.00 mm,and the mitral valve size was 27.72±3.13 mm.Cardiopulmonary bypass time was 195.81±39.29 min,aortic cross-clamping time was 121.81±28.60 min,mechanical ventilation time was 15.09±3.72 h,ICU stay time was 3.09±0.70 days,and total postoperative thoracic drainage volume was 417.18±68.65 mL.There was no perioperative death.Conclusion Commando procedure is a safe and effective method to perform combined valve operation for mechanical valve dysfunction.A larger artificial valve can be implanted during the procedure to obtain sound hemodynamic effects.In addition,for elderly patients,a suitable type of bioprosthetic valve can be implanted to improve the patient's quality of life.The early surgical effect is satisfactory,and the long-term impact needs further follow-up.
作者
陈波
范婷
曹勇
余观水
胡楝
朱任
CHEN Bo;FAN Ting;CAO Yong;YU Guanshui;HU Lian;ZHU Ren(Department of Cardiovascular Surgery,Gaozhou People's Hospital,Gaozhou,525200,Guangdong,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2024年第6期838-841,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
2021年广东省医学科学技术研究基金(B2021339)。
