Signorello L B, Kennedy J A, Richmond R A, Sieu K L, Blot W J, Harrison D C
International Epidemiology Institute, Rockville, MD, USA.
J Heart Valve Dis. 2001 Mar;10(2):210-8.
The risk of fracture of Björk-Shiley convexo-concave (BSCC) prosthetic heart valves has resulted in consideration of prophylactic explantation and replacement for patients with high-risk valves. Little information exists on perceived quality of life, health status, and serious morbidity among BSCC patients, including those who have undergone explantation.
Self-administered questionnaires were completed by a cohort of 585 BSCC patients who participated in an X-ray imaging study to detect precursors to valve fracture up to seven years (average 3.9 years) previously. Responses from 31 explant patients were contrasted with those from 554 BSCC patients in whom explant surgery was not attempted.
Perceived quality of life and health status and risk of hospitalization after participating in the imaging study varied considerably among patients, but on average tended not to differ significantly between those with and without explants. A slightly greater proportion of explantees tended to report both improved health status and high rates of heart attack and pacemaker implantation. The health status of these patients was, in general, considerably worse than previously reported among valve implant patients. Over half the cohort were hospitalized during follow up, and half were unable to walk up more than one flight of stairs without shortness of breath.
The less than optimal health status of most BSCC patients and relatively high rates of morbidity should be taken into account when considering potential explantation of the valves.
Björk-Shiley 凸凹型（BSCC）人工心脏瓣膜存在骨折风险，这使得人们考虑对高风险瓣膜患者进行预防性瓣膜取出和置换。关于 BSCC 患者，包括那些已经接受瓣膜取出手术的患者的生活质量、健康状况和严重发病率的信息很少。
585 名 BSCC 患者完成了自填式问卷调查，这些患者参与了一项 X 光成像研究，该研究旨在检测瓣膜骨折的先兆，时间跨度长达七年（平均 3.9 年）。将 31 名接受瓣膜取出手术患者的回答与 554 名未尝试进行瓣膜取出手术的 BSCC 患者的回答进行对比。
参与成像研究后，患者对生活质量和健康状况的感知以及住院风险差异很大，但总体而言，有瓣膜取出手术和没有进行该手术的患者之间平均差异不显著。接受瓣膜取出手术的患者中，略多一部分人倾向于报告健康状况有所改善，同时心脏病发作和起搏器植入率也较高。这些患者的健康状况总体上比之前报道的瓣膜植入患者差得多。超过一半的队列在随访期间住院，并且一半患者爬一层以上楼梯就会气短。
在考虑是否对瓣膜进行潜在的取出手术时，应考虑到大多数 BSCC 患者健康状况欠佳以及发病率相对较高的情况。
