Sjögren Johan, Gudbjartsson Tomas, Thulin Lars I
Department of Cardiothoracic Surgery, Heart and Lung Center, Lund University Hospital, Lund, Sweden.
J Heart Valve Dis. 2006 Mar;15(2):197-202.
The current trend in Europe and the USA demonstrates an increased number of tissue valves being implanted. However, studies presenting long-term follow up of the Mitroflow pericardial bioprosthesis are relatively scarce. In the present study, the long-term outcome of the Mitroflow in the aortic position was analyzed in a geriatric population using actuarial statistics; risk factors for early and late mortality were also evaluated.
Between 1990 and 1993, 152 elderly (mean age 79.5 +/- 3.1 years; range: 75-91 years) patients each received a Mitroflow bioprosthesis implanted in the aortic position. A follow up was conducted in January 2003 and was 100% complete. Concomitant coronary artery bypass grafting was performed in 74 patients (49%). Valve-related outcomes were evaluated using actuarial statistics. Overall survival was compared to that in an age- and gender-matched population. A multivariate analysis of risk factors for mortality was also performed.
Actuarial freedom from structural valve deterioration was 99% and 82% at five and 10 years, respectively. Actuarial freedom from stroke, bleeding, prosthetic valve endocarditis and valve explant at 10 years were 80 +/- 5%, 94 +/- 3%, 93 +/- 3% and 89 +/- 4%, respectively. Risk factors for mortality during follow up were male gender, small valves (< or = 21 mm), preoperative NYHA class III/IV, greater age, and long intraoperative perfusion time.
The Mitroflow pericardial bioprosthesis demonstrated a good long-term performance after aortic valve replacement, suggesting it to be a feasible option in elderly patients.
欧洲和美国目前的趋势显示，植入的组织瓣膜数量有所增加。然而，关于Mitroflow心包生物瓣膜长期随访的研究相对较少。在本研究中，使用精算统计方法分析了老年人群中Mitroflow生物瓣膜在主动脉位置的长期转归；还评估了早期和晚期死亡的危险因素。
1990年至1993年间，152例老年患者（平均年龄79.5±3.1岁；范围：75 - 91岁）均接受了Mitroflow生物瓣膜主动脉瓣置换术。2003年1月进行了随访，随访率达100%。74例患者（49%）同期进行了冠状动脉旁路移植术。使用精算统计方法评估瓣膜相关转归。将总体生存率与年龄和性别匹配的人群进行比较。还对死亡危险因素进行了多因素分析。
5年和10年时，瓣膜结构退化的精算免发生率分别为99%和82%。10年时，中风、出血、人工瓣膜心内膜炎和瓣膜取出的精算免发生率分别为80±5%、94±3%、93±3%和89±4%。随访期间死亡的危险因素为男性、小瓣膜（≤21 mm）、术前纽约心脏协会（NYHA）心功能III/IV级、年龄较大以及术中灌注时间长。
Mitroflow心包生物瓣膜在主动脉瓣置换术后显示出良好的长期性能，表明它是老年患者的一种可行选择。
