González-Juanatey J R, Rubio Alvarez J, Sierra Quiroga J, Durán Muñoz D, Gil de la Peña M, García-Bengoechea J B
Servicio de Cirugía Cardíaca, Hospital General de Galicia, Santiago de Compostela.
Rev Esp Cardiol. 1990 Jan;43(1):6-12.
With the aim to asses the thrombogenicity of "treated" bovine pericardial tissue, the incidence of thromboembolism with Ionescu-Shiley pericardial bioprostheses was analyzed in 349 operative survivors since January 1977. A total of 376 valves were available for the study. Mean age was 59 years. Preoperatively atrial fibrillation was present in 68.2% (91.7% of the mitral replacement group) and 62% were in NYHA functional class III-IV; in 10.6% previous embolism had been documented. Early anticoagulation (8-12 weeks) was administered in the first 232 patients (113 mitral replacements, 98 aortic replacements and 21 multiple replacements) and the rest of the patient population had no anticoagulation at all. Thromboembolic events were documented in 13 patients (3.72%) or 0.84% per patient/annum (1.49% per patient/annum for mitral and multiple replacements and 0.13% per patient/annum for aortic replacements). Early thromboembolism was detected in 6 patients (3 months after surgery), all in anticoagulated patients, three being in sinus rhythm. No valve thrombosis was detected in this series. Three patients with late thromboembolism were in NYHA functional class III-IV. Ten thromboembolic events were central (1 died and three had permanent neuro-residua). In two the location was peripheral and another one in the kidney. The Ionescu-Shiley pericardial bioprosthesis after 11 years has demonstrated a low thrombogenicity in the absence of chronic anticoagulation. Early anticoagulation does not influence the rate of thromboembolism during this period and therefore we believe that this therapeutic approach is not justified despite the presence of risk factors.
为评估“处理过的”牛心包组织的血栓形成倾向，自1977年1月起，对349例手术存活者中使用Ionescu-Shiley心包生物假体后血栓栓塞的发生率进行了分析。共有376个瓣膜可供研究。平均年龄为59岁。术前，68.2%的患者存在房颤（二尖瓣置换组中为91.7%），62%的患者纽约心脏协会（NYHA）心功能分级为III-IV级；10.6%的患者曾有栓塞记录。前232例患者（113例二尖瓣置换、98例主动脉置换和21例多次置换）接受了早期抗凝治疗（8 - 12周），其余患者完全未接受抗凝治疗。有13例患者（3.72%）发生血栓栓塞事件，即每位患者每年发生率为0.84%（二尖瓣置换和多次置换患者为每位患者每年1.49%，主动脉置换患者为每位患者每年0.13%）。6例患者（术后3个月）发生早期血栓栓塞，均为接受抗凝治疗的患者，其中3例为窦性心律。本系列研究中未检测到瓣膜血栓形成。3例发生晚期血栓栓塞的患者NYHA心功能分级为III-IV级。10例血栓栓塞事件发生在中枢部位（1例死亡，3例有永久性神经后遗症）。2例发生在周围部位，另1例发生在肾脏。Ionescu-Shiley心包生物假体在使用11年后，在未进行长期抗凝的情况下显示出较低的血栓形成倾向。在此期间，早期抗凝治疗并未影响血栓栓塞发生率，因此我们认为，尽管存在危险因素，但这种治疗方法并不合理。
