Opelative Risk and Results of Reoporation for Heart Valve Prostheses

인공심장판막 재치환술에 대한 수술 위험 인자 및 결과

  • 김철환 (국립의료원 흉부외과) ;
  • 김경훈 (국립의료원 흉부외과, 대구 가톨릭대학 흉부외과)
  • Published : 1997.10.01

Abstract

We reviewed data of 64 patients who underwent reoperation because of prosthetic valve malfunction from January 1991 to December 1995. The indications for reoperation were prosthetic valve failure(primary tissue failure: 53 patients, 82.8%), prosthetic valve thrombosis(6 patients, 9.4%), paravalvular leak(3 patients, 4.7%), prosthetic valve endocarditis(2 patients, 3.6%). Prosthetic valve failure developed most frequently in mitral portion(40 patients, 75%), prosthetic valve thrombosis also in mitral portion(4 patients, 67%), paravalvular leak significantly in aortic portio (3 patients, 100%). Explant period was longest in prosthetic valve failure(mean 107.4 $\pm$ 24.6 months), shortest in prosthetic valve endocarditis with prosthetic valve thrombosis(1 patient, 1 month). Mean explant period, defined as from first valve replacement operation to redo-valve replacement operatopn, was 109.2$\pm$ 10.7 months in mitral portion, 97.8$\pm$ 10.4 months in aortic portion, 109.5$\pm$ 10.4 months in total. Overall hospital mortality was 9.38%. The most common cause of death was the low cardiac output(4 patients), other causes were bleeding(1 patient), CNS injury(1 patient). Preoperative NYHA class IV(P=0.011), emergency operation(P=0.011), prosthetic valve endocarditis(P=0.001) were the independent risk factors, but age, sex, explant period, ACC time, double valve replacement, valve position, second reoperation did not appear to be significant risk factors. Mean follow up period was 28.8 $\pm$ 17.8 months. Actuarial survival at 3 year was 92.0$\pm$6.2%, 2 year event-free survival w s 84.3$\pm$6.1%. We propose that patients undergoing reoperation because of prosthetic valve failure are carfully controlled and selected in regarding to above mentioned risk factors NYHA class IV, emergency operation, prosthetic valve endocarditis in preoperative state. About other risk factors possible, there is necessary of following study.

본원에서는 1991년 1월부터 1995년 12월까지 64명의 환자가 인공심장판막의 이상으로 재치환술을 받았다. 주로 판막자체의 기능부전으로 53명(82.8%)이 재수술을 받았으며, 나머지는 판막혈전증으로 6명(9.4%), 판막 주위의 누출로 3명(4.7%), 심내막염으로 2명(3.6%)이 재수술을 받았다. 판막자체의 기능부전(40명, 75%)과 판 막혈전증(4명, 67%)은 주로 승모판막에서 호발하였으며, 판막 주위의 누출(3명, 100%)은 대동맥판막에서 발 생하였다. 가장 긴 적출기간 첫번째 인공심장판막 치환술을 받은 후로부터 재수술을 받기까지의 기간 은 판막자체의 기능부전으로 평균 107.4$\pm$24.6개월이었고, 판막혈전증을 동반한 심내막염(1명)에서 1개월로 가 장 짧았다. 대동맥판막과 승모판막에서 평균 적출기간은 각각 109.5$\pm$10.4, 109.2$\pm$10.7개월이었다. 전체 병원 사망율은 9.38%(6/64), 저심박출증이 4명으로 가장 많았고 기타 출혈 및 중추신경계 손상이 각각 1례씩 있었 다. 독립적인 술후 위 험 인자로는, 술전 MilD class W(P=0.011), 응급 수술(P=0.011), 심내막염(P=0.001) 들이 의미가 있었으며 기타 나이, 성별, 대동맥차단시간, 적출기간, 중복 판막 치환술 2차 재치환술, 판막위치 등 은 술후 위험 인자로서 통계학적 의미가 없었다. 평균 추적기간은 28.8$\pm$17.8개월이었고, 3년 누적 생존율은 92.0$\pm$6.2%, 2년 무합병 생존율은 84.3$\pm$6.1%였다. 인공심장판막 실패로 인하여 재수술을 받아야할 환자에 있어서, 위에서 언급한 위험 인자 술전 miBs class W, 응급 수술, 심내막염의 관점에서 술전 상태를 잘 조절하여 재수술을 시행하여야 한다. 가능한 다른 위험 인자에 대해서도 추후 연구가 필요하다.

Keywords

References

  1. Ann Thorac Surg v.46 Guidelines for reporting morbidity and mortality after acquired cardiac valve operations Edmunds LH Jr;Clark RE;Cohn LH;Miller DC;Wiesel RD
  2. J Thorac Cardiovasc Surg v.89 The porcine bio prosthetic valve : twelve years later Magilligan DJ;Lewis JW;Tilly B(et al)
  3. Ann Thorac Surg v.47 Intrinsic failure of Hancock mitral bioprosthesis : 10-15 year experience Foster AH;Greenberg GJ;Underhill DJ;McIntosh CL;Clark RE
  4. Ann Thorac Surg v.48 A 10-year comparison of mitral valve replacement with Carpentier-Edwards and Hancock porcine bioprosthesis Perier P;Deloche A;Chauvaud S(et al)
  5. 대흉외지 v.25 이종 조직판막의 내구성 김종환
  6. 대흉외지 v.24 인공 심장 판막 실패에 대한 재치환술의 임상적 고찰 최병철
  7. Ann Thorac Surg v.50 Reoperations on heart valve prostheses : an analysis of operative risk and late results Pansini S;Ottine G;Forsennati G(et al)
  8. Ann Thorac Surg v.42 Reoperations for valve surgery : perioperative mortality and determinants of risk for 1,000 patients Lytle BW;Cosgrove DM;Taylor DC(et al)
  9. 대흉외지 v.28 인공 심장 판막의 재치환술 김관민
  10. Circulation v.72 Death and other time-related events after valve replacement Blackstone EH;Kirklin JW
  11. Cardiovasc Surg v.2 Reoperative cardiac valve surgery : multivariable analysis of risk factors Biglioli P;DiMatteo S;Parolari A;Antona C;Arena V;Sala A
  12. Ann Thorac Surg v.56 Decrease in operative risk of reoperative valve surgery Cohn LH;Aranki SF;Rizzo RJ;Adams DH;Cogswell KA(et al)
  13. J Thorac Cardiovasc Surg v.88 Early and late prognosis after reoperations for prosthetic valve replalcement Bosch X;Poman JL;Pelletier CL(et al)
  14. Circulation v.69 Prosthetic valve endocarditis Ivert TSA;Dismukes WE;Cobbs CG(et al)