Alvarez L, Escudero C, Figuera D, Castillo-Olivares J L
Service of Experimental Surgery, Hospital Puerta de Hierro, Madrid, Spain.
J Thorac Cardiovasc Surg. 1992 Nov;104(5):1249-58.
The long-term follow-up of 831 patients who underwent valve replacement with Björk-Shiley Delrin and standard Pyrolyte prostheses (341 aortic, 345 mitral, and 145 mitroaortic) between 1971 and 1980 is reviewed. The follow-up concluded in 1985. Cumulative follow-up amounted to 4724 years, with a mean of 5.68 years per patient. Data on survival were obtained in 754 patients (complete follow-up in 90.8% of cases). Perivalvular leak was the most frequent complication in aortic valve replacement, whether isolated or combined, with values significantly higher than those registered in isolated mitral replacement (p < 0.001 in both cases). No correlation was found between this complication and valve calcification, but it was statistically correlated with the size 19 model (p < 0.05). Prosthetic stenosis was more common in mitral than in aortic replacement (p < 0.001), and of the former, size 23 was that most often affected (p < 0.001). The earliest case of mitral pannus was diagnosed 20 months postsurgery, and from 45 months on this pathology was the cause of every case of stenosis. The risk of thromboembolism was similar in aortic, mitral, and double prostheses, while it was the single most frequent complication in isolated mitral replacement. Prosthetic thrombosis was triggered in all cases in which it occurred by discontinuance of anticoagulant therapy. Anticoagulant-induced hemorrhages were more frequent in double replacement than in mitral (p < 0.05) and aortic valve replacement. Endocarditis was the complication that produced the highest mortality rate in all groups; the frequency of this infection was higher among patients with double prostheses when compared with either aortic replacement (p < 0.05) or mitral replacement (p < 0.001). The risk of suffering endocarditis was correlated with the existence of active preoperative infection in patients with mitral prostheses and double prostheses (p < 0.001 in both cases). Overall morbidity was higher in the double replacement group with respect to the mitral group (p < 0.01). The rate of mortality was also higher among the double valve replacement patients when compared with both the aortic (p = 0.0002) and mitral (p = 0.006) groups.
回顾了1971年至1980年间接受Björk-Shiley Delrin瓣膜和标准热解碳假体瓣膜置换术的831例患者（341例主动脉瓣置换、345例二尖瓣置换和145例二尖瓣-主动脉瓣置换）的长期随访情况。随访于1985年结束。累积随访时间达4724年，平均每位患者随访5.68年。754例患者获得了生存数据（90.8%的病例为完整随访）。无论是单纯主动脉瓣置换还是联合置换，瓣周漏都是主动脉瓣置换术中最常见的并发症，其发生率显著高于单纯二尖瓣置换（两种情况均p < 0.001）。未发现该并发症与瓣膜钙化之间存在相关性，但与19号型号存在统计学相关性（p < 0.05）。人工瓣膜狭窄在二尖瓣置换中比在主动脉瓣置换中更常见（p < 0.001），在前者中，23号型号最常受累（p < 0.001）。二尖瓣心内膜炎最早在术后20个月被诊断出来，从45个月起，这种病理情况是每例狭窄的原因。主动脉瓣、二尖瓣和双瓣膜置换的血栓栓塞风险相似，而在单纯二尖瓣置换中它是最常见的单一并发症。所有发生人工瓣膜血栓形成的病例均是由于停用抗凝治疗所致。抗凝剂引起的出血在双瓣膜置换中比在二尖瓣（p < 0.05）和主动脉瓣置换中更常见。心内膜炎是所有组中导致死亡率最高的并发症；与主动脉瓣置换（p < 0.05）或二尖瓣置换（p < 0.001）相比，双瓣膜置换患者中这种感染的发生率更高。二尖瓣假体和双瓣膜置换患者发生心内膜炎的风险与术前存在活动性感染相关（两种情况均p < 0.001）。双瓣膜置换组的总体发病率高于二尖瓣组（p < 0.01）。与主动脉瓣置换组（p = 0.0002）和二尖瓣置换组（p = 0.006）相比，双瓣膜置换患者的死亡率也更高。
