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題 名 | Experience with Patients 70 Years and Older Undergoing Valve Replacement Surgery=70歲以上老年病患人工瓣膜置換術之經驗 |
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作 者 | 林佳勳; 呂明仁; 洪啟仁; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 15:1 1999.01[民88.01] |
頁 次 | 頁25-32 |
分類號 | 416.262 |
關鍵詞 | 人工瓣膜; 老年病患; 抗凝血劑治療; Prostetic valves; Elderly patients; Anticoagulation therapy; |
語 文 | 英文(English) |
中文摘要 | 背景:瓣膜置換常是心臟瓣膜手術中不可避免的決定,對於老年病患,因為沒有完全理想的人工瓣膜,所以該選擇組織或是機械瓣膜仍是有所爭議的。基於近年來平均壽命的延長,70歲以上老年病患接受瓣膜置換手術逐漸增加,依傳統上選擇組織瓣膜時,可能必須考慮到這些老年病患在80歲以後,因為組織瓣膜退化損壞,必須接受再度手術,此時會有相當高的危險性與合併症的發生。而選擇耐用性較好的機械瓣膜時,老年病患必須長期服用抗凝血劑的安全性,也是必須相當注意的。 方法:從1992年11月至1996年12月,本院共有22例70歲以上病患接受瓣膜置換手術,其中有13例主動脈瓣置換,5例二尖瓣膜置換以及4例雙瓣膜置換。我們沿用傳統上為老年病患選擇 25 號以上的組織瓣膜,因為小尺寸的組織瓣膜往往會產生相當的瓣膜壓力差而影響預後;如病患的瓣膜環較小時,則選擇機械瓣膜,因為瓣膜環擴大手術會延長手術時間,對老年病患較不合適,而且當瓣膜環有鈣化時,更是困難。 結果:22例中共有8例組織瓣膜和14例機械瓣膜置換。結果早期有3例死亡,原因為手術後心臟衰竭與敗心症,晚期死亡有2例為慢性腎衰竭急性惡化與阻塞性肺疾併發呼吸衰竭。另有一例81歲高血壓病患接受主動脈機械瓣膜,於27個月後發生一次輕微中風,其餘病患在追蹤期間(6至45個月)皆預後良好,沒有發生與抗凝血劑有關的合併症。 結論:機械瓣膜可以安全地使用於70歲以上的老年病患以減少因組織瓣膜退化損壞而必須於80歲以後接受再度手術的危險。年齡老不是服用抗凝血劑的禁忌,但必須注意的是,對於長期服用抗凝血劑的老年病患較密切的監測與追蹤,可以使此治療更為安全。 |
英文摘要 | Background: Since the "ideal" prosthetic valve does not exist, a surgeon has to select tissue or mechanical prosthesis when valve replacement procedure is necessary. There is still controversy over the selection of bioprosthesis for elderly patients. With regard to age, the current increasing life expectancy of patients operated on at the age of 70 and older, the poorer durability of bioprostheses, and the greater surgical risk of reoperations in octogenarians should be considered. Methods: From November 1992 to December 1996, 22 patients of ages 70 and older received valves replacement surgery. There were 5 cases of mitral valve replacement (MVR), 13 cases of aortic valve replacement (AVR), and 4 cases of double valve replacement. Among the AVR group, there were 3 patients with other concomitant cardiac procedures; two had coronary artery bypass grafting (CABG) and one had ascending aortic reconstruction with reimplantation of coronary orifices (Bentall's operation) due to aortic aneurysm. Our policy is to use Carpentier-Edwards porcine valves in patients of age 70 or older with an aortic annulus of 25 mm or larger. Otherwise, a St. Jude Medical mechanical valve will be the choice. Therefore, St. Jude Medical mechanical valves were used in 14 cases and Carpentier-Edwards porcine valves were used in 8 cases. Results: The mean follow-up period was 24.4 months (6-45 months). There were 3 patients who suffered from early operative death because of postoperative cardiac deterioration and sepsis. Two late deaths were imputed to chronic renal failure with acute exacerbation and chronic obstructive pulmonary disease with respiratory failure. An 81 year-old patient with hypertension developed a minor stroke at 27th month postoperatively. Other patients were doing well with no valve-related complications having occurred. Conclusion: Our experience documents acceptable early results associated with the use of mechanical prostheses in patients 70 years and older. By way of using mechanical valves, we can simply manage the small aortic annulus without complicated annulus enlarging procedures and can easily anticipate the advantage of avoiding the greater surgical risk of reoperations in octogenarians due to bioprosthesis degeneration. |
本系統中英文摘要資訊取自各篇刊載內容。