Villemot Jean-Pierre, Lekehal Malik, Maureira Pablo, Vanhuyse Fabrice, Sirbu Christina, Carteaux Jean-Pierre, Tran Nguyen
Department of Cardiothoracic Surgery and Transplantation, University-Hospital of Nancy-Brabois, Vandoeuvre-lès-Nancy, France.
J Heart Valve Dis. 2008 Nov;17(6):648-56.
The study aim was to update the authors' experience with aortic valve replacement (AVR) using the ATS mechanical prosthesis in terms of early and long-term outcome in routine practice.
This retrospective analysis was extracted from clinical data available between April 1996 and February 2005, of AVR with the ATS Medical prosthesis in 510 consecutive patients (345 men, 165 women; mean age 62 +/- 12 years), of whom 296 underwent isolated AVR (iAVR). Concomitant surgical procedures included coronary artery bypass grafting (AVR+CABG, n = 47), mitral valve procedure (AVR+MVP, n = 59), ascending aortic replacement (AVR+AAR, n = 74) and other procedures (AVR+Miscellaneous, n = 34). Early and late morbidity/mortality were analyzed for the entire group in case of emergency surgery, preoperative low left ventricular ejection fraction (LVEF <50%) and in elderly people (age > or = 70 years).
The overall 30-day mortality was 7.2% (iAVR 4.7%; AVR+CABG 4%; AVR+MVP 8.5%; AVR+AAR 2.9%; AVR+Miscellaneous 14.7%). The five- and nine-year global survival rates were respectively 81.14 +/- 2.4% and 67.02 +/- 10.4%. Long-term survival was lower in case of emergency surgery (p = 0.001), when the preoperative LVEF was <50% (p = 0.03), and when patients were aged > or = 70 years (p = 0.0005). Linearized postoperative valve-related death was 1.1% per patient-year (pt-yr). However, nine years' freedom from valve-related death and valve-related morbidity were not significantly different when the patient age was > or = 70 years. The linearized rate for postoperative thromboembolism complication was 0.4% per pt-yr, and that for postoperative bleeding complication 0.63% per pt-yr. There were two perivalvular leaks (0.05%/pt-yr). Neither valve thrombosis, structural dysfunction nor endocarditis were observed.
The findings of this retrospective study point to a globally very good performance of the ATS valve, and essentially similar to previously reported results with these and other available mechanical valves.
本研究旨在更新作者使用ATS机械瓣膜进行主动脉瓣置换术（AVR）在常规临床实践中的早期和长期结果方面的经验。
本回顾性分析提取自1996年4月至2005年2月期间510例连续接受ATS医用瓣膜主动脉瓣置换术患者（345例男性，165例女性；平均年龄62±12岁）的临床资料，其中296例行单纯主动脉瓣置换术（iAVR）。同期手术包括冠状动脉旁路移植术（AVR+CABG，n = 47）、二尖瓣手术（AVR+MVP，n = 59）、升主动脉置换术（AVR+AAR，n = 74）以及其他手术（AVR+杂项，n = 34）。对急诊手术、术前左心室射血分数低（LVEF<50%）以及老年患者（年龄≥70岁）的整个队列进行早期和晚期发病率/死亡率分析。
总体30天死亡率为7.2%（iAVR为4.7%；AVR+CABG为4%；AVR+MVP为8.5%；AVR+AAR为2.9%；AVR+杂项为14.7%）。5年和9年总生存率分别为81.14±2.4%和67.02±10.4%。急诊手术（p = 0.001）、术前LVEF<50%（p = 0.03）以及患者年龄≥70岁（p = 0.0005）时，长期生存率较低。术后瓣膜相关死亡的线性化发生率为每患者年1.1%（pt-yr）。然而，患者年龄≥70岁时，9年无瓣膜相关死亡和瓣膜相关并发症的情况无显著差异。术后血栓栓塞并发症的线性化发生率为每pt-yr 0.4%，术后出血并发症的线性化发生率为每pt-yr 0.63%。有2例瓣周漏（0.05%/pt-yr）。未观察到瓣膜血栓形成、结构功能障碍或心内膜炎。
这项回顾性研究的结果表明ATS瓣膜总体性能非常好，与先前报道的这些及其他可用机械瓣膜的结果基本相似。
