Björk V O
Heart Institute of the Desert, Eisenhower Medical Centre, Rancho Mirage, California 92270.
Can J Cardiol. 1989 Jan-Feb;5(1):64-73.
Aortic valve replacement with Bjork-Shiley tilting disc valves in 1753 patients gave a 15 year actuarial survival of 54%. Better results were obtained in narrow aortic roots and in pure aortic stenosis than in pure aortic insufficiency. Anti-coagulation was necessary. Bleeding was the most common complication and the most common valve related cause of death. With the monostrut, no valve thrombosis nor mechanical failure was encountered during five years and a low gradient of 11 mmHg and an effective orifice area of 1.4 cm2 was obtained in cases with a 21 mm valve. Mitral valve replacement with 810 Bjork-Shiley valves gave a 15 year actuarial survival of 51%. Most complications such as embolism, valve thrombosis, reoperations and deaths have the highest incidences during the first postoperative year. Anticoagulation related bleeding continued at a constant rate. The convexo-concave valve decreased the incidence of valve thrombosis significantly without any increase in bleeding complications but was complicated by some strut fractures, especially among the 70 degrees convexo-concave valves. With the monostrut Bjork-Shiley valve the risk of strut fracture was eliminated and valve thrombosis has not occurred during the first five years in patients properly anticoagulated at the Karolinska Hospital, Stockholm, Sweden.
1753例患者接受了Bjork-Shiley倾斜碟瓣主动脉瓣置换术，15年实际生存率为54%。与单纯主动脉瓣关闭不全相比，主动脉根部狭窄和单纯主动脉瓣狭窄患者的手术效果更好。抗凝是必要的。出血是最常见的并发症，也是与瓣膜相关的最常见死亡原因。对于单柱型瓣膜，5年内未发生瓣膜血栓形成或机械故障，对于植入21mm瓣膜的患者，测得的跨瓣压差低至11mmHg，有效瓣口面积为1.4cm²。810例患者接受了Bjork-Shiley瓣膜二尖瓣置换术，15年实际生存率为51%。大多数并发症，如栓塞、瓣膜血栓形成、再次手术和死亡，在术后第一年的发生率最高。抗凝相关出血持续以恒定速率发生。凸凹型瓣膜显著降低了瓣膜血栓形成的发生率，且出血并发症未增加，但出现了一些支柱骨折，尤其是70度凸凹型瓣膜。对于单柱型Bjork-Shiley瓣膜，在瑞典斯德哥尔摩卡罗林斯卡医院接受适当抗凝治疗的患者中，前五年未发生支柱骨折，也未出现瓣膜血栓形成。
