Zusammenfassung
Im Zeitraum zwischen dem 1. 1. 1987 und dem 30. 6. 1994 erhielten insgesamt 267 Patienten in der Klinik für Thorax-, Herz- und Gefäßchirurgie der Medizinischen Hochschule Hannover einen Mitralklappenersatz als Zweiteingriff, nachdem diese bereits vorher einem Herzeingriff, in den meisten Fällen an der Mitralklappe, unterzogen worden waren. 23 klinische und hämodynamische Variablen wurden retrospektiv untersucht, um Einflußgrößen des Re-Eingriffes zu ermitteln. 160 (60%) Frauen und 107 (40%) Männer bildeten das Gesamtkollektiv. Das durchschnittliche Alter zum Zeitpunkt der Reoperation betrug 58,3±10,6 Jahre. Die operative Mortalität lag bei 8,2% (22 von 267 Patienten). Im Mittel waren zwischen Vor- und Reoperation 108,6±70,8 Monate vergangen. Eine Unterteilung in Untergruppen nach den begleitenden Prozeduren neben dem Mitralklappenersatz erbrachte keine signifikanten Unterschiede hinsichtlich der Mortalitätsrate.
Variablen mit univariater Signifikanz waren einAlter bei Reoperation über 65 Jahre (p=0,007), eine unterNotfallbedingungen durchgeführte Operation (p<0,0001), präoperativ überlebteMyokardinfarkte (p=0,019), eine präoperativ eingeschränkteNierenfunktion (p=0,047), ein präoperativ über 140 μmol/l erhöhterSerum-Kreatinin-Spiegel (p<0,0001), ein über 12 mmHg erhöhterlinksventrikulärer enddiastolischer Druck (p=0,043), derKatecholamin-Index (p<0,0001) sowie die postoperativen Komplikationenakutes Nierenversagen (p=0,03),Sepsis (p<0,0001) undlow-output-Syndrom (p<0,0001).
In der anschließenden für prä-, intra- und postoperative Variablen getrennt durchgeführten Multivarianzanalyse gingen dieNotfalloperation (p=0,006), derlinksventrikuläre enddiastolische Druck (p=0,05), dieOperationsdauer (p=0,0054), dieAortenklemmzeit (p=0,0061), derKatecholamin-Index (p=0,023), daslow-output-Syndrom (p<0,0001) sowie dieSepsis (p=0,02) als unabhängige Risikofaktoren hervor.
Summary
Since the introduction of the prosthetic heart valve replacement many studies identified risk factors affecting the early and late operative outcome, Improvement of the operative technique and prosthetic devices led to a continuously decreased operative mortality. At the same time an increasing number of patients are requiring reoperation. Mainly the bioprosthetic devices predominantly implanted in the seventies and eighties led to reoperations due to structural valve degeneration. This retrospective study was designed to identify risk factors of the perioperative period. Therefore, twenty-three clinical and hemodynamical variables were evaluated for their effect on the early operative outcome. 267 patients undergoing isolated or combined mitral valve replacement between January 1, 1987, and June 30, 1994, as a reoperation after previous intrapericardial surgery were included. In eighty percent of the population, bioprosthetic heart valves had been implanted at the time of the primary procedure. The mean age was 58.3±10.6 years. There were 160 females and 107 males, and the mean interval was 108.6±70.8 months. The operative mortality rate was 8.2% (22/267). A subdivision in groups with isolated MVR, combined MVR and AVR, combined MVR and tricuspid valve reconstruction, and MVR with complex procedures showed no significant differences.
In the univariate analysis age (>65; p=0.007), an emergency operation (p<0.0001), preoperative myocardial infarctions (p=0.019), an impaired renal function (p=0.047), creatinine blood levels >140 μmol/l (p<0.0001), a LVEDP>12 mmHg (p=0.043), a catecholamine-index (p<0.0001), the postoperative complications acute renal failure (ARF; p=0.03), low-outputsyndrome (LOS; p<0.0001), and sepsis (p<0.0001) were associated with operative mortality.
As independent risk factors we identified an emergency operation (p=0.006), the LVEDP>12 mmHg (p=0.05), the operation time (p=0.0045), the aortic cross clamping time (p=0.0061), the catecholamine-index (p=0.023), the LOS (p<0.0001), and a sepsis (p=0.02).
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Nagib, R.M., Krieg, P., Fieguth, H.G. et al. Mitralklappenersatz im Rahmen von Reoperationen am Herzen. Z. Herz-, Thorax-, Gefäßchir. 11, 270–276 (1997). https://doi.org/10.1007/BF03045202
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DOI: https://doi.org/10.1007/BF03045202