Vohra Hunaid A, Whistance Robert N, Baliulis Gedrius, Janusauskas Vilius, Kaarne Marrkku, Veldtman Gruschen R, Roman Kevin, Vettukattil Joseph J, Gnanapragasam James, Salmon Anthony P, Haw Marcus P
Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, United Kingdom.
Thorac Cardiovasc Surg. 2012 Apr;60(3):205-9. doi: 10.1055/s-0031-1295573. Epub 2012 Mar 12.
To examine the midterm clinical outcome of pulmonary valve replacement (PVR) with prosthetic valves.
We reviewed 37 consecutive patients who underwent PVR with biological prosthetic valves between September 1999 and June 2010. The median age was 22.6 years (range: 6 to 70 years; three children). The primary diagnosis was Tetralogy of Fallot in 20 patients (54%). Valve pathology was regurgitation in 27 patients (72.9%). Cardiac surgery had been previously performed in 35 patients (94.5%). The median size of the prosthesis was 25 mm (range: 21 to 31 mm). The median follow-up was 42 months (range: 1.2 to 129 months).
There were no early valve-related deaths. Hospital mortality was 2.7% (n = 1) and no patient required early rereplacement of prosthesis. Two patients required permanent pacemaker insertion. During follow-up, there was no late death, reoperation for structural valve degeneration, or valve thrombosis. Only one patient required repeated operation for endocarditis at 37 months follow-up. The actuarial survival at 5 years was 95.1 ± 3.8%. Overall freedom from reoperation after PVR at 5 years was 93.0 ± 8.6%. At last follow-up, 34 patients (91.8%) were NYHA class I versus 20 patients (54%) preoperatively (p < 0.05). In the 35 surviving patients who did not undergo redo-PVR, there was no-mild regurgitation and the peak PV gradient was 20.4 ± 10.2 mm Hg (16.2 ± 9.3 mm Hg preoperatively). Thirty-two patients (91.4%) had good right ventricular function compared with 26 patients (74.2%) preoperatively.
PVR with biological prosthetic valves can be performed with good midterm survival, functional status, and haemodynamics.
研究使用人工瓣膜进行肺动脉瓣置换术（PVR）的中期临床疗效。
我们回顾了1999年9月至2010年6月期间连续37例行生物人工瓣膜PVR的患者。中位年龄为22.6岁（范围：6至70岁；3名儿童）。主要诊断为法洛四联症的患者有20例（54%）。瓣膜病变为反流的患者有27例（72.9%）。35例患者（94.5%）曾接受过心脏手术。人工瓣膜的中位尺寸为25 mm（范围：21至31 mm）。中位随访时间为42个月（范围：1.2至129个月）。
无早期瓣膜相关死亡。住院死亡率为2.7%（n = 1），无患者需要早期再次置换人工瓣膜。2例患者需要植入永久性起搏器。随访期间，无晚期死亡、因结构性瓣膜退变再次手术或瓣膜血栓形成。仅1例患者在随访37个月时因心内膜炎需要再次手术。5年时的精算生存率为95.1±3.8%。PVR术后5年总体再次手术率为93.0±8.6%。在最后一次随访时，34例患者（91.8%）为纽约心脏协会（NYHA）心功能I级，而术前为20例患者（54%）（p < 0.05）。在35例未进行再次PVR的存活患者中，无轻度反流，肺动脉峰值压差为20.4±10.2 mmHg（术前为16.2±9.3 mmHg）。32例患者（91.4%）右心室功能良好，而术前为26例患者（74.2%）。
使用生物人工瓣膜进行PVR可获得良好的中期生存率、功能状态和血流动力学效果。
