Cohn L H, Sanders J H, Collins J J
Circulation. 1976 Dec;54(6 Suppl):III60-3.
From July 1970 through December 1974, 109 patients underwent isolated mitral valve replacement (MVR). A Harken prosthetic disc valve (DVR) was used in 53 patients and glutaraldehyde-preserved Hancock porcine xenograft (PVR) in 56 patients. The functional class, distribution of mitral valve pathology, and incidence of atrial fibrillation were similar in both groups. There were no operative and three (5.5%) late deaths in the PVR group and two (3.8%) operative and ten (19.5%) late deaths in the DVR group. Anticoagulants were not used in the PVR group; there were 3 nonfatal emboli (10%), all occurring in patients with atrial fibrillation and large left atria. Although anticoagulants were used there were 14 emboli (five in patients who died, nine nonfatal) in the DVR group (26.4%). In our experience, there is a significant reduction in morbidity and mortality, primarily from a reduced risk of thromboemboli, if a porcine valve is used for MVR. Anticoagulants should be used in patients with atrial fibrillation and enlarged left atria regardless of the type of valve used.
1970年7月至1974年12月期间，109例患者接受了单纯二尖瓣置换术（MVR）。53例患者使用了哈肯人工机械瓣（DVR），56例患者使用了戊二醛保存的汉考克猪异种移植物瓣膜（PVR）。两组患者的心功能分级、二尖瓣病变分布及房颤发生率相似。PVR组无手术死亡，3例（5.5%）晚期死亡；DVR组2例（3.8%）手术死亡，10例（19.5%）晚期死亡。PVR组未使用抗凝剂；有3例非致命性栓塞（10%），均发生在房颤和左心房增大的患者中。尽管使用了抗凝剂，但DVR组仍有14例栓塞（5例发生在死亡患者中，9例非致命）（26.4%）。根据我们的经验，如果使用猪瓣膜进行二尖瓣置换术，发病率和死亡率会显著降低，主要是因为血栓栓塞风险降低。无论使用何种瓣膜，房颤和左心房增大的患者均应使用抗凝剂。
