Jugdutt B I, Fraser R S, Lee S J, Rossall R E, Callaghan J C
J Thorac Cardiovasc Surg. 1977 Jul;74(1):20-7.
The experience with tricuspid valve replacement (TVR) with seven different prostheses, alone or combined with replacement of other valves, in 73 patients (64 rheumatic and nine nonrheumatic) between 1964 and March, 1975, at the University of Alberta Hospital has been reviewed. Early and late mortality rates in rheumatic patients were 41 and 23 percent, respectively (36 percent being alive after a mean of 5.6 years), compared to 33 and 11 percent, respectively, in the nonrheumatic patients (56 percent being alive after a mean of 2 years). Of all survivors, 88 percent were functionally improved. Among the rheumatic patients: (1) 88 percent had organic tricuspid disease; (2) of the 39 patients with tricuspid insufficiency who underwent corrective mitral surgery 7 years before TVR, the tricuspid insufficiency had progressed over the 7 years; (3) the number of patients with tricuspid insufficiency had increased (39 versus 59) over the same 7 year period; (4) a high early mortality rate was encountered in those who were preoperatively in New York Heart Association (N.Y.H.A.) Class IV, or who had cardiomegaly, or pulmonary hypertension, or poor ventricular function, or organic disease, or reoperation; (5) the percentages of survivors with different prostheses were: Starr-Edwards, 31 percent; Beall-Surgitool, 14 percent; Kay-Shiley, 46 percent, Björk-Shiley, 50 percent; Lillehei-Kaster, 100 percent; Cutter-Smeloff and Wada-Cutter, nil. Among the nonrheumatic patients, two with the Cutter-Smeloff, two with the Beall-Surgitool, and one with the Lillehei-Kaster were alive after 14, 37, and 15 months, respectively. Among all survivors of TVR, late thrombus and pannus developed on both ball and disc prostheses (Starr-Edwards, two; Cutter-Smeloff, one; Lillehei-Kaster, one). These findings suggest that TVR should be performed earlier in rheumatic patients to reduce the operative mortality rate and that the Lillehei-Kaster prosthesis is probably most suitable for TVR.
对1964年至1975年3月间在阿尔伯塔大学医院73例患者（64例风湿性和9例非风湿性）中使用7种不同人工瓣膜单独或联合其他瓣膜置换进行三尖瓣置换（TVR）的经验进行了回顾。风湿性患者的早期和晚期死亡率分别为41%和23%（平均5.6年后36%存活），而非风湿性患者分别为33%和11%（平均2年后56%存活）。在所有幸存者中，88%功能得到改善。在风湿性患者中：（1）88%患有器质性三尖瓣疾病；（2）在TVR前7年接受二尖瓣矫正手术的39例三尖瓣关闭不全患者中，三尖瓣关闭不全在7年中有所进展；（3）在同一7年期间，三尖瓣关闭不全患者数量增加（从39例增至59例）；（4）术前纽约心脏病协会（N.Y.H.A.）IV级、有心脏扩大、肺动脉高压、心室功能差、器质性疾病或再次手术的患者早期死亡率高；（5）不同人工瓣膜的存活百分比为：Starr-Edwards，31%；Beall-Surgitool，14%；Kay-Shiley，46%；Björk-Shiley，50%；Lillehei-Kaster，100%；Cutter-Smeloff和Wada-Cutter，0。在非风湿性患者中，2例使用Cutter-Smeloff、2例使用Beall-Surgitool和1例使用Lillehei-Kaster的患者分别在14、37和15个月后存活。在TVR的所有幸存者中，球型和盘型人工瓣膜（Starr-Edwards，2例；Cutter-Smeloff，1例；Lillehei-Kaster，1例）均出现晚期血栓和血管翳。这些发现表明，风湿性患者应尽早进行TVR以降低手术死亡率，且Lillehei-Kaster人工瓣膜可能最适合TVR。
