Blot William J, Ibrahim Michel A, Ivey Tom D, Acheson Donald E, Brookmeyer Ron, Weyman Arthur, Defauw Joseph, Smith J Kermit, Harrison Donald
International Epidemiology Institute, Rockville, MD, USA.
Circulation. 2005 May 31;111(21):2850-7. doi: 10.1161/CIRCULATIONAHA.104.511659.
The first Björk-Shiley convexoconcave (BSCC) prosthetic heart valves were implanted in 1978. The 25th anniversary provided a stimulus to summarize the research data relevant to BSCC valve fracture, patient management, and current clinical options.
Published and unpublished data on the risks of BSCC valve fracture and replacement were compiled, and strategies for identifying candidates for prophylactic valve reoperation were summarized. By December 2003, outlet strut fractures (OSFs), often with fatal outcomes, had been reported in 633 BSCC valves (0.7% of 86,000 valves implanted). Fractures still continue to occur, but average rates of OSFs in 60 degrees valves are now <0.1% per year. OSF risk varies markedly by valve characteristics, especially valve angle and size, with weaker effects associated with other manufacturing variables. OSF risks are mildly lower among women than men but decline sharply with advancing age. The risks of valve replacement typically greatly exceed those of OSF. By comparing individualized estimated risks of OSF versus valve replacement, guidelines have been developed to identify the small percentage of BSCC patients (mostly younger men) who would be expected to have a gain in life expectancy should reoperative surgery be performed.
Twenty-five years after the initial BSCC valve implants, fractures continue to occur. Continued monitoring of BSCC patients is needed to track and quantify risks and enable periodic updating of guidelines for patients and their physicians.
首例 Björk-Shiley 凸凹型（BSCC）人工心脏瓣膜于 1978 年植入。25 周年之际促使人们总结与 BSCC 瓣膜破裂、患者管理及当前临床选择相关的研究数据。
汇编了已发表和未发表的关于 BSCC 瓣膜破裂及置换风险的数据，并总结了识别预防性瓣膜再次手术候选者的策略。截至 2003 年 12 月，已报告 633 例 BSCC 瓣膜出现出口支柱骨折（OSF），常导致致命后果（占植入的 86,000 枚瓣膜的 0.7%）。骨折仍在继续发生，但 60 度瓣膜的 OSF 年平均发生率目前<0.1%。OSF 风险因瓣膜特征（尤其是瓣膜角度和尺寸）而有显著差异，其他制造变量的影响较弱。女性的 OSF 风险略低于男性，但随年龄增长急剧下降。瓣膜置换的风险通常大大超过 OSF 的风险。通过比较 OSF 与瓣膜置换的个体化估计风险，已制定指南以识别一小部分 BSCC 患者（主要是年轻男性），若进行再次手术，预期其预期寿命会有所增加。
在最初植入 BSCC 瓣膜 25 年后，骨折仍在发生。需要持续监测 BSCC 患者，以追踪和量化风险，并使针对患者及其医生的指南能够定期更新。
