Peterseim D S, Cen Y Y, Cheruvu S, Landolfo K, Bashore T M, Lowe J E, Wolfe W G, Glower D D
Departments of Surgery and Medicine, Duke University Medical Center, Durham NC, USA.
J Thorac Cardiovasc Surg. 1999 May;117(5):890-7. doi: 10.1016/S0022-5223(99)70368-5.
The purpose of this study was to optimize selection criteria of biologic versus mechanical valve prostheses for aortic valve replacement.
Retrospective analysis was performed for 841 patients undergoing isolated, first-time aortic valve replacement with Carpentier-Edwards (n = 429) or St Jude Medical (n = 412) prostheses.
Patients with Carpentier-Edwards and St Jude Medical valves had similar characteristics. Ten-year survival was similar in each group (Carpentier-Edwards 54% 3% versus St Jude Medical 50% 6%; P =.4). Independent predictors of worse survival were older age, renal or lung disease, ejection fraction less than 40%, diabetes, and coronary disease. Carpentier-Edwards versus St Jude Medical prostheses did not affect survival (P =.4). Independent predictors of aortic valve reoperation were younger age and Carpentier-Edwards prosthesis. The linearized rates of thromboembolism were similar, but the linearized rate of hemorrhage was lower with Carpentier-Edwards prostheses (P <.01). Perivalvular leak within 6 months of operation was more likely with St Jude Medical than with Carpentier-Edwards prostheses (P =.02). Estimated 10-year survival free from valve-related morbidity was better for the St Jude Medical valve in patients aged less than 65 years and was better for the Carpentier-Edwards valve in patients aged more than 65 years. Patients with renal disease, lung disease (in patients more than age 60 years), ejection fraction less than 40%, or coronary disease had a life expectancy of less than 10 years.
For first-time, isolated aortic valve replacement, mechanical prostheses should be considered in patients under age 65 years with a life expectancy of at least 10 years. Bioprostheses should be considered in patients over age 65 years or with lung disease (in patients over age 60 years), renal disease, coronary disease, ejection fraction less than 40%, or a life expectancy less than 10 years.
本研究旨在优化主动脉瓣置换生物瓣膜与机械瓣膜假体的选择标准。
对841例行单纯首次主动脉瓣置换术的患者进行回顾性分析，其中使用Carpentier-Edwards瓣膜（n = 429）或圣犹达医疗公司瓣膜（n = 412）。
使用Carpentier-Edwards瓣膜和圣犹达医疗公司瓣膜的患者具有相似特征。每组的10年生存率相似（Carpentier-Edwards瓣膜组为54% ± 3%，圣犹达医疗公司瓣膜组为50% ± 6%；P = 0.4）。生存率较低的独立预测因素为年龄较大、肾病或肺病、射血分数低于40%、糖尿病和冠心病。Carpentier-Edwards瓣膜与圣犹达医疗公司瓣膜对生存率无影响（P = 0.4）。主动脉瓣再次手术的独立预测因素为年龄较小和使用Carpentier-Edwards瓣膜假体。血栓栓塞的线性化发生率相似，但Carpentier-Edwards瓣膜假体的出血线性化发生率较低（P < 0.01）。术后6个月内，圣犹达医疗公司瓣膜比Carpentier-Edwards瓣膜更易发生瓣周漏（P = 0.02）。对于年龄小于65岁的患者，圣犹达医疗公司瓣膜的估计10年无瓣膜相关并发症生存率较好；对于年龄大于65岁的患者，Carpentier-Edwards瓣膜的情况较好。患有肾病、肺病（年龄大于60岁的患者）、射血分数低于40%或冠心病的患者预期寿命小于10年。
对于首次单纯主动脉瓣置换术，预期寿命至少10年的65岁以下患者应考虑使用机械瓣膜假体。65岁以上患者或患有肺病（年龄大于60岁的患者）、肾病、冠心病、射血分数低于40%或预期寿命小于10年的患者应考虑使用生物瓣膜假体。
