Grocott-Mason R M, Lund O, Elwidaa H, Mazhar R, Chandrasakeran V, Mitchell A G, Ilsley C, Khaghani A, Rees A, Yacoub M
Department of Cardiology and Academic Department of Cardiac Surgery, Harefield Hospital, Harefield, Middlesex, U.K.
Eur Heart J. 2000 Oct;21(20):1698-707. doi: 10.1053/euhj.1999.2040.
The aim of this study was to assess the influence of valve substitute (homograft vs prosthetic valve) on the long-term survival and late valve-related complication rates following aortic valve replacement in patients with aortic valve disease and congestive heart failure.
The effect of choice of valve substitute on outcome after aortic valve replacement in patients with pre-operative heart failure is unknown. The superior haemodynamic profile of homografts may be of particular benefit.
We retrospectively analysed pre-operative, operative and follow-up data on 518 adults in functional classes III and IV, who, over the 25 years 1969-1993, had their initial aortic valve replacement at Harefield hospital. Follow-up conducted during 1996 to April 1997 and totalling 4439 patient-years was 96.1% complete. Using multivariate analysis, independent risk factors for different complications and mortality were defined.
Overall 5-, 10- and 20-year survival was 80+/-2%, 62+/-2% and 30+/-3%, respectively, with no significant difference between valve types. However, homografts (n=381) independently reduced the rate of serious complications and cardiac death, whereas mechanical valves were an independent adverse risk factor for late mortality. The rates of anticoagulant-related bleeding and thromboembolism were increased by mechanical valves, whereas primary tissue failure was the main complication of homografts.
Long-term outcome of homograft aortic valve replacement in patients with congestive heart failure is acceptable, with a reduced rate of serious complications and cardiac death. Further improvements would be expected if the rate of primary tissue failure could be reduced.
本研究旨在评估瓣膜替代物（同种异体移植物与人工瓣膜）对患有主动脉瓣疾病和充血性心力衰竭的患者进行主动脉瓣置换术后长期生存率和晚期瓣膜相关并发症发生率的影响。
术前存在心力衰竭的患者，瓣膜替代物的选择对主动脉瓣置换术后结局的影响尚不清楚。同种异体移植物优越的血流动力学特征可能具有特别的益处。
我们回顾性分析了1969年至1993年这25年间在哈雷菲尔德医院首次接受主动脉瓣置换术的518例III级和IV级功能的成年患者的术前、手术及随访数据。1996年至1997年4月进行的随访，总计4439患者年，完成率为96.1%。采用多变量分析确定不同并发症和死亡率的独立危险因素。
总体5年、10年和20年生存率分别为80±2%、62±2%和30±3%，瓣膜类型之间无显著差异。然而，同种异体移植物（n = 381）独立降低了严重并发症和心源性死亡的发生率，而机械瓣膜是晚期死亡率的独立不良危险因素。机械瓣膜增加了抗凝相关出血和血栓栓塞的发生率，而原发性组织衰竭是同种异体移植物的主要并发症。
充血性心力衰竭患者同种异体主动脉瓣置换术的长期结局是可以接受的，严重并发症和心源性死亡的发生率降低。如果能降低原发性组织衰竭的发生率，有望进一步改善。
