Louagie Y, Noirhomme P, Aranguis E, Eucher P, Vanruyssevelt P, Buche M, Dion R, Jaumin P, Schoevaerdts J C, Chalant C H
Department of Cardiovascular and Thoracic Surgery, Catholic University of Louvain, Brussels, Belgium.
J Thorac Cardiovasc Surg. 1992 Oct;104(4):1013-24.
The Carpentier-Edwards bioprosthesis was implanted in 369 patients (414 valves) between May 1977 and December 1987 (age 67.2 +/- 0.5 years); 242 had aortic valve replacement, 80 had mitral valve replacement, 44 had multiple valve replacement, of which 41 were aortic and mitral valve replacement, 2 had isolated tricuspid valve replacement, and 1 had a pulmonary valve replacement. The selection criteria were the following: shorter life expectancy (253 patients) or contraindications to anticoagulants for organic (113 patients) or psychologic (38 patients) reasons, or both. The early mortality rate was 11.1% (aortic valve replacement, 9.1%; mitral valve replacement, 12.4%; aortic and mitral valve replacement, 23.1%). Total cumulative follow-up was 1456 pt-yr (mean 4.4 years, range 1 to 148 months), and the patient evaluation was 99.5% complete. Late mortality was 4.9%/pt-yr. Five-year survival was 70.4% +/- 2.7% overall, 74.3% +/- 3.2% after aortic valve replacement, 60.9% +/- 6.2% after mitral valve replacement (p < 0.03), and 60.7% +/- 8.1% after aortic and mitral valve replacement. Eight patients were reoperated on for primary tissue failure, and freedom from reoperation for structural valve deterioration was 97.5% +/- 1.2% at 5 years and 95.6% +/- 1.8% at 8 years. Failing aortic bioprostheses were explanted in four patients (0.4%/pt-yr) and mitral bioprostheses in seven (1.6%/pt-yr). No patient whose valve was inserted after the age of 70 had to be reoperated on for structural valve dysfunction. The probability of freedom from thromboembolism after 5 and 8 years of follow-up was 93.1% +/- 1.6% and 92.2% +/- 1.8%, respectively. The prevalence of anticoagulant-related hemorrhage was 0.8%/pt-yr (major 0.6%, minor 0.2%). Anticoagulants had to be maintained in 16.3% of the patients: 5.9% after aortic valve replacement, 35.7% after mitral valve replacement, and 45.8% after aortic and mitral valve replacement, while 80.0% were on a regimen of antiplatelet drug therapy. Prosthetic valve endocarditis happened in five patients (0.3%/pt-yr). Freedom from all valve-related morbidity and mortality, including hospital deaths, was 71.0% +/- 2.7% at 5 years and 58.6% +/- 4.6% at 8 years and was significantly better in the aortic valve replacement group (61.3% +/- 6.6% at 8 years) compared with the mitral valve replacement group (54.4% +/- 7.7% at 8 years; p = 0.04). This study confirms the satisfactory performance of the Carpentier-Edwards valve after aortic valve replacement in elderly patients.(ABSTRACT TRUNCATED AT 400 WORDS)
1977年5月至1987年12月期间，369例患者（共植入414枚瓣膜）植入了卡朋蒂埃-爱德华兹生物瓣膜（年龄67.2±0.5岁）；其中242例行主动脉瓣置换术，80例行二尖瓣置换术，44例行多瓣膜置换术，其中41例为主动脉瓣和二尖瓣置换术，2例为单纯三尖瓣置换术，1例为肺动脉瓣置换术。选择标准如下：预期寿命较短（253例患者）或因器质性（113例患者）或心理性（38例患者）原因或两者兼有而存在抗凝禁忌证。早期死亡率为11.1%（主动脉瓣置换术为9.1%；二尖瓣置换术为12.4%；主动脉瓣和二尖瓣置换术为23.1%）。总累积随访时间为1456患者年（平均4.4年，范围1至148个月），患者评估完成率为99.5%。晚期死亡率为4.9%/患者年。总体五年生存率为70.4%±2.7%，主动脉瓣置换术后为74.3%±3.2%，二尖瓣置换术后为60.9%±6.2%（p<0.03），主动脉瓣和二尖瓣置换术后为60.7%±8.1%。8例患者因原发性组织衰竭再次手术，5年和8年时因结构性瓣膜退变免于再次手术的比例分别为97.5%±1.2%和95.6%±1.8%。4例患者（0.4%/患者年）的主动脉生物瓣膜失效后被取出，7例患者（1.6%/患者年）的二尖瓣生物瓣膜失效后被取出。70岁以后植入瓣膜的患者无一人因结构性瓣膜功能障碍而需再次手术。随访5年和8年后免于血栓栓塞的概率分别为93.1%±1.6%和92.2%±1.8%。抗凝相关出血的发生率为0.8%/患者年（严重出血为0.6%，轻微出血为0.2%）。16.3%的患者必须持续使用抗凝剂：主动脉瓣置换术后为5.9%，二尖瓣置换术后为35.7%，主动脉瓣和二尖瓣置换术后为45.8%，而80.0%的患者采用抗血小板药物治疗方案。5例患者发生人工瓣膜心内膜炎（0.3%/患者年）。5年和8年时免于所有瓣膜相关发病率和死亡率（包括医院死亡）的比例分别为71.0%±2.7%和58.6%±4.6%，与二尖瓣置换术组（8年时为54.4%±7.7%；p = 0.04）相比，主动脉瓣置换术组（8年时为61.3%±6.6%）的情况明显更好。本研究证实了卡朋蒂埃-爱德华兹瓣膜在老年患者主动脉瓣置换术后的良好性能。（摘要截选至400字）
