Jegaden O, Perinetti M, Barthelet M, Vedrinne C, Delahaye F, Montagna P, Mikaeloff P
Hôpital cardiovasculaire et pneumologique Louis Pradel, Lyon.
Arch Mal Coeur Vaiss. 1992 Oct;85(10):1413-8.
Between 1974 and 1990, 58 patients underwent tricuspid valve replacement with a porcine bioprosthesis (Hancock 42, Carpentier-Edwards 16) in the course of polyvalvular replacement (double 21, triple 37). Early postoperative mortality was 12%: 16 patients died secondarily, usually of cardiac causes. The actuarial survival (1 patient lost to follow-up) was 81 +/- 11% at 5 years and 60 +/- 17% at 10 years. Two patients were reoperated for dysfunction of a Hancock bioprosthesis, 11 and 15 years after implantation. At long-term, with an average follow-up of 108 +/- 48 months, 82% of survivors (28/34) were clinically improved. Doppler echocardiography was performed in 29 patients in February 1991. In 21 cases, with a follow-up of 88 +/- 40 months, the bioprosthesis was normal with an average diastolic transprosthetic pressure gradient of 3.8 +/- 1.7 mmHg. In 7 patients followed up for 129 +/- 40 months (p < 0.05) moderate dysfunction of the Hancock prosthesis was observed with a mean diastolic pressure. Severe dysfunction of a Hancock prosthesis was observed in 1 case. Fixed pulmonary hypertension was noted in 11 cases and was associated with a poor clinical result and a raised mean diastolic transprosthetic pressure gradient. The durability and haemodynamic performance of tricuspid porcine bioprostheses are satisfactory in the long term. Prosthetic dysfunction is correlated to the duration of implantation of the bioprosthesis and to persistent pulmonary hypertension.
1974年至1990年间，58例患者在进行多瓣膜置换术（双瓣膜置换21例，三瓣膜置换37例）时采用猪生物瓣膜（Hancock瓣膜42例，Carpentier-Edwards瓣膜16例）进行了三尖瓣置换。术后早期死亡率为12%：16例患者继发死亡，通常死于心脏原因。5年时的精算生存率（1例失访）为81±11%，10年时为60±17%。2例患者分别在植入Hancock生物瓣膜11年和15年后因瓣膜功能障碍接受了再次手术。长期来看，平均随访108±48个月，82%的幸存者（28/34）临床症状改善。1991年2月对29例患者进行了多普勒超声心动图检查。其中21例，随访88±40个月，生物瓣膜正常，平均舒张期跨瓣膜压力阶差为3.8±1.7 mmHg。7例随访129±40个月的患者（p<0.05）观察到Hancock瓣膜有中度功能障碍，平均舒张压升高。1例患者观察到Hancock瓣膜严重功能障碍。11例患者存在固定性肺动脉高压，与临床预后不良及平均舒张期跨瓣膜压力阶差升高有关。三尖瓣猪生物瓣膜的耐久性和血流动力学性能长期来看令人满意。人工瓣膜功能障碍与生物瓣膜植入时间及持续性肺动脉高压相关。
