Jegaden O, Llojeh K, Montagna P, Rossi R, Adeleine P, Delaye J, Delahaye J P, Mikaeloff P
Service de chirurgie cardiovasculaire, hôpital Cardiologiqué, Lyon.
Arch Mal Coeur Vaiss. 1991 Jan;84(1):47-54.
Between 1970 and 1985, 596 patients underwent isolated aortic valve replacement with a Björk-Shiley prosthesis: 448 men and 148 women, average age 52 +/- 13 years (range 10-78 years). The valve lesion was aortic stenosis in 158 cases, aortic regurgitation in 218 cases and mixed valve disease in 220 cases. Fifty-four per cent of patients had invalidating cardiac failure (Stage III of the NYHA Classification). Thirteen per cent of patients had an associated non valvular surgical procedure. The hospital mortality was 5.7% and 77% of the early deaths were of cardiac origin. Results were analysed after an average follow-up period of 90 +/- 15 months, a total of 3817 patient-years. The late mortality was 94 (16.7%). Actuarial survival was 87 +/- 1% at 5 years and 79 +/- 2% at 10 years. A prognostic score was established from a multifactorial analysis: Cox = 0.44 (NYHA Stage 1, 2, 3, 4) + 5.29 C/T (absolute value) + 1.15 associated procedure (0.1) + 0.65 (RBBB) (0.1). In the long-term, 84.8% of survivors were asymptomatic (NYHA Stages I and II). The incidence of thrombo-embolism was 0.5/100 patient-years. At 10 years, 95% of patients had no thromboembolic complication. The incidence of ineffective endocarditis was 0.3/100 patient-years and that of complications of anticoagulant therapy was 0.4/100 patient-years. The incidence of valve dehiscence was 0.1/100 patient-years and the reoperation rate was 0.4/100 patient-years but there were no cases of valve dysfunction. The global complication rate in this series was 1.35/100 patient-years. These results confirm the good results of aortic valve replacement with a mechanical prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
1970年至1985年间，596例患者接受了使用Björk-Shiley人工瓣膜的单纯主动脉瓣置换术：男性448例，女性148例，平均年龄52±13岁（范围10 - 78岁）。瓣膜病变为主动脉瓣狭窄158例，主动脉瓣关闭不全218例，混合性瓣膜病220例。54%的患者有失代偿性心力衰竭（纽约心脏协会分级III级）。13%的患者有相关的非瓣膜外科手术。医院死亡率为5.7%，早期死亡的77%源于心脏。平均随访90±15个月（共3817患者年）后分析结果。晚期死亡率为94例（16.7%）。5年时精算生存率为87±1%，10年时为79±2%。通过多因素分析建立了一个预后评分：Cox = 0.44（纽约心脏协会I、II、III、IV级）+ 5.29 C/T（绝对值）+ 1.15相关手术（0或1）+ 0.65（右束支传导阻滞）（0或1）。长期来看，84.8%的幸存者无症状（纽约心脏协会I级和II级）。血栓栓塞发生率为0.5/100患者年。10年时，95%的患者无血栓栓塞并发症。感染性心内膜炎发生率为0.3/100患者年，抗凝治疗并发症发生率为0.4/100患者年。瓣膜裂开发生率为0.1/100患者年，再次手术率为0.4/100患者年，但无瓣膜功能障碍病例。本系列的总体并发症发生率为1.35/100患者年。这些结果证实了机械人工瓣膜进行主动脉瓣置换术的良好效果。（摘要截短至250字）
