目的 观察机械瓣置换、生物瓣置换及瓣膜成形手术对≥60岁单纯二尖瓣病变患者远期疗效的影响. 方法 2006年1月至2008年12月116例≥60岁的单纯二尖瓣手术出院患者,风湿性二尖瓣病变76例,二尖瓣退行性病变40例.人工机械瓣膜置换62例,生物瓣膜置换34例,二尖瓣成形术20例.门诊或电话随访,记录死亡、再次手术、感染性心内膜炎、瓣周漏、心功能分级、抗凝情况、出血事件、血栓栓塞等事件. 结果 116例患者随访24～60月,平均(48.4±10.7)月.20例瓣膜成形的患者,随访期间无死亡病例,二尖瓣功能良好,未出现中度以上返流、再次住院、再次手术及其他不良事件.34例生物瓣膜置换的患者,均口服阿司匹林抗凝,随访期间未出现瓣膜衰败现象,瓣膜功能正常,心功能均明显改善.62例机械瓣置换的患者,均服用华法林抗凝,机械瓣膜功能良好,心功能明显改善.可见感染性心内膜炎、瓣周漏、出血事件及血栓栓塞等事件发生. 结论 手术治疗≥60岁二尖瓣病变患者的疗效显著,能明显改善患者心功能,延长生存时间.但不同术式的远期效果有一定差异.瓣膜成形术后避免抗凝药物的应用,可避免抗凝并发症.生物瓣膜置换可达到瓣膜成形术的效果,但因其存在生物衰败,可能需要再次手术,在年龄相对低的患者中根据情况选择.机械瓣膜置换需要终生抗凝治疗,影响远期效果的主要因素为出血和血栓并发症,严格规律地监测凝血指标,可最大程度减少抗凝并发症的发生,提高治疗效果.%Objective To study the long-term results of mechanical valve replacement, bioprosthetic valve replacement or valve plasty in elderly patients with mitral valve disease. Methods From January 2006 to December 2008, 116 cases , received mitral valve surgery and were discharged. Among all the patients, 76 cases suffered from rheumatic mitral valve disease, 40 cases suffering from mitral degenerative disease. Mechanical valve replacement was carried out in 62 cases, biological valve replacement in 34 cases and mitral valvuloplasty in 20 cases. The events of death, reoperation, infective endocarditis, paravalvular leakage, cardiac function, anticoagulation,bleeding events, thromboembolism were recorded by outpatient clinic interview or telephone follow-up. Results 116 patients were followed up for 24 to 60 months and the mean time of follow-up was 48. 4 ±10. 7 months. During the follow-up, mitral valve function was good in 20 cases of valvuloplasty and there were no deaths, moderate regurgitation, readmission, reoperation, and other adverse events. Biological valves function were normal in 34 cases of biological valve replacement, and during follow-up period the poatieuts aspirin was used to prevent coagulation. There were no valve decline and no adverse events. The cardiac function was significantly improved. All 62 cases of mechanical valve replacement were taking warfarin with good mechanical valve function and the heart function improved significantly. The events of infective endocarditis, paravalvular leakage, bleeding and thromboembolism occurred. Conclusions Surgical treatment of mitral valve disease in elderly patients could significantly improve cardiac function and prolong survival time. However, the long-term effects of different surgical procedures have some differences. Valvuloplasty could a-void the application of anticoagulation drugs. Biological valve replacement can be as good as valvuloplasty, but biological decay may lead to re-operation in the relatively low-age patients. Mechanical valve replacement requires lifelong anticoagulation therapy, and the main factors affecting the long-term effects are bleeding and thrombotic complications.
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