CALLAGHAN J C
Can Med Assoc J. 1964 Aug 29;91(9):411-21.
The aortic and mitral valves were replaced in 50 patients at the University of Alberta Hospital using the Starr-Edwards ball-valve prosthesis. The basis of the selection of 20 patients for isolated aortic valve replacement and 27 for mitral valve replacement using this type of prosthesis is presented, and the techniques of insertion of the aortic and mitral valve are described in detail. Of the 27 patients in whom the mitral valve was replaced by the Starr-Edwards prosthesis six died within 30 days of surgery and two after discharge from hospital at two and a half and four months, respectively. Left atrial thrombosis was the cause of death in four of these patients. In 20 patients in whom the aortic valve was replaced, four died in hospital and two died more than 30 days after returning home. Three of these six patients died from bleeding-the result of the use of anticoagulants. The difficulty in assessing whether or not anticoagulants are needed following replacement by a Starr-Edwards prosthesis is considered. It is felt, in our present state of knowledge, that anticoagulants should be used following mitral valve replacement but are probably not essential following replacement of the aortic valve. Two patients survived replacement of both aortic and mitral valves and have been followed up 18 months and seven months, respectively.
在阿尔伯塔大学医院，50例患者使用斯塔尔-爱德华兹球瓣假体进行了主动脉瓣和二尖瓣置换术。介绍了选择20例患者进行单纯主动脉瓣置换术以及27例患者进行二尖瓣置换术的依据，并详细描述了主动脉瓣和二尖瓣的植入技术。在27例使用斯塔尔-爱德华兹假体进行二尖瓣置换的患者中，6例在术后30天内死亡，2例分别在出院后两个半月和四个月死亡。其中4例患者死于左心房血栓形成。在20例进行主动脉瓣置换的患者中，4例在医院死亡，2例在回家30多天后死亡。这6例患者中有3例死于出血，这是使用抗凝剂的结果。文中考虑了评估在使用斯塔尔-爱德华兹假体置换后是否需要抗凝剂的困难。就我们目前的知识水平而言，认为二尖瓣置换术后应使用抗凝剂，但主动脉瓣置换术后可能并非必需。2例患者在主动脉瓣和二尖瓣置换术后存活，分别接受了18个月和7个月的随访。
