二尖瓣位使用ATS机械瓣膜的10年经验。

10-year experience with the ATS mechanical valve in the mitral position.

作者信息

Stefanidis Constantin, Nana Albert M, De Cannière Didier, Antoine Martine, Jansens Jean-Luc, Huynh Chi-Hoang, Le Clerc Jean-Louis

机构信息

Department of Cardiac Surgery, Erasme Hospital, Free University of Brussels, Brussels, Belgium.

出版信息

Ann Thorac Surg. 2005 Jun;79(6):1934-8. doi: 10.1016/j.athoracsur.2005.01.002.

DOI:10.1016/j.athoracsur.2005.01.002

PMID:15919287

Abstract

BACKGROUND

The ATS Medical Open Pivot mechanical heart valve was introduced in 1992. Previous reports have focused on the low rate of thromboembolic complications in the aortic position. The purpose of this retrospective study is to analyze the rate of midterm thromboembolic events and other valve-related complications when the ATS Open Pivot valve is implanted in the mitral position.

METHODS

Between June 1992 and June 2002, 177 patients (63 male and 114 female; mean age 57.5 years) underwent mitral replacement with an ATS Open Pivot mechanical heart valve. Preoperatively, 17 patients (10%) were in New York Heart Association functional class II, 117 patients (66%) in class III, and 43 patients (24%) in class IV. Seventy-four patients (42%) were in chronic atrial fibrillation. Seventy-four mitral valve replacements (42%) were associated with other cardiac procedures. Etiologies included degenerative disease (56%), rheumatic disease (38%), and endocarditis (6%). On the second postoperative day, 100 mg acetylsalicylic acid and oral acenocoumarol (Sintrom) was introduced to obtain a target INR of 2.0 to 3.0. All patients were followed up by one cardiologist and underwent annual transthoracic echocardiographic examination.

RESULTS

Percent follow-up was 90.4%. Data represent 724 total patient-years. Mean follow-up was 48 +/- 34 months (range, 1 to 119). Operative morbidity was 15%. Overall hospital mortality was 2.8% (5 patients). At hospital discharge, the mean INR for all the patients was 2.38 +/- 0.68 (range, 1.32 to 6.44). Five early neurologic complications occurred: 3 transient cerebrovascular accidents and 2 strokes. Three late transient cerebrovascular ischemic accidents occurred at 3, 4, and 6 years, respectively. No other complications such as paravalvular leak, valve dysfunction, thrombosis, or valve explant occurred. Postoperative echocardiographic data revealed low mean pressure gradient as related to the valvular size.

CONCLUSIONS

The ATS Medical Open Pivot mitral valve demonstrates low rates of bleeding, thromboembolic, and other valve-related complications.

摘要

背景

ATS医用开放枢轴机械心脏瓣膜于1992年推出。既往报告主要关注其在主动脉位置时血栓栓塞并发症的低发生率。本回顾性研究的目的是分析将ATS开放枢轴瓣膜植入二尖瓣位置时中期血栓栓塞事件及其他瓣膜相关并发症的发生率。

方法

1992年6月至2002年6月期间，177例患者（63例男性和114例女性；平均年龄57.5岁）接受了使用ATS开放枢轴机械心脏瓣膜的二尖瓣置换术。术前，17例患者（10%）处于纽约心脏协会心功能II级，117例患者（66%）处于III级，43例患者（24%）处于IV级。74例患者（42%）存在慢性心房颤动。74例二尖瓣置换术（42%）与其他心脏手术相关。病因包括退行性疾病（56%）、风湿性疾病（38%）和心内膜炎（6%）。术后第二天，开始使用100mg阿司匹林和口服醋硝香豆素（新抗凝），以使国际标准化比值（INR）达到2.0至3.0的目标值。所有患者均由一名心脏病专家进行随访，并每年接受经胸超声心动图检查。

结果

随访率为90.4%。数据代表724个患者年。平均随访时间为48±34个月（范围1至119个月）。手术并发症发生率为百分之十五。总体医院死亡率为2.8%（5例患者）。出院时，所有患者的平均INR为2.38±0.68（范围1.32至6.44）。发生了5例早期神经系统并发症：3例短暂性脑血管意外和2例中风。分别在3年、4年和6年发生了3例晚期短暂性脑血管缺血性意外。未发生其他并发症，如瓣周漏、瓣膜功能障碍、血栓形成或瓣膜取出。术后超声心动图数据显示，与瓣膜大小相关的平均压力梯度较低。