Aoyagi S, Tanaka K, Nishi Y, Yamashita M, Oryoji A, Hara H, Kosuga K, Oishi K
Second Department of Surgery, Kurume University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Aug;39(8):1126-31.
During the 10-year period between 1980 and December 1989, isolated mitral valve replacement (MVR) with the St. Jude Medical (SJM) valve prosthesis was performed on 404 patients at our hospital, and a long-term postoperative follow-up was conducted. There were 161 males and 243 females ranged in age from 1 year to 73 years. Early operative mortality was 5.2%. Follow-up period for 383 patients who discharged from the hospital was 1970.7 patient-years. Twenty of these patients died during the follow-up period, and a late mortality rate was 5.2%. During 10 years, thromboembolic event occurred in 8 patients. Four patients had anticoagulant-related bleeding, 4 had paravalvular leak, and 5 underwent re-operations. There was neither structural valve failure nor prosthetic valve endocarditis. Therefore, the actuarial survival rate and the valve-related death-free rate at 10 years were 83.2%, and 96.8%. Of the patients who survived, New York Heart Association class improved significantly (93% in classes II and III preoperatively and 71% in class I postoperatively). Linearized rates for thromboembolism, anticoagulant-related bleeding, and hemolysis were 0.41%, 0.20% and 0.36%/100 patient-years, respectively. The actuarial estimate of incidence free from all complications was 92.0% at 10 years. On the basis of this 10 years' experience, we believe that the SJM valve prosthesis is an excellent mechanical prosthesis for mitral valve replacement, in terms of hemodynamic performance and low thrombogenicity in patients receiving anticoagulants.
在1980年至1989年12月的10年期间，我院对404例患者实施了采用圣犹达医疗（SJM）瓣膜假体的单纯二尖瓣置换术（MVR），并进行了长期术后随访。其中男性161例，女性243例，年龄从1岁至73岁不等。早期手术死亡率为5.2%。383例出院患者的随访期为1970.7患者年。这些患者中有20例在随访期间死亡，晚期死亡率为5.2%。10年间，8例患者发生血栓栓塞事件。4例患者出现抗凝相关出血，4例有瓣周漏，5例接受了再次手术。未发生结构性瓣膜失效和人工瓣膜心内膜炎。因此，10年的精算生存率和瓣膜相关无死亡率分别为83.2%和96.8%。存活患者中，纽约心脏协会心功能分级显著改善（术前II级和III级患者占93%，术后I级患者占71%）。血栓栓塞、抗凝相关出血和溶血的线性化发生率分别为0.41%、0.20%和0.36%/100患者年。10年无所有并发症发生的精算估计发生率为92.0%。基于这10年的经验，我们认为就血流动力学性能和接受抗凝治疗患者的低血栓形成性而言，SJM瓣膜假体是二尖瓣置换的优良机械假体。
