Saito Satoshi, Tsukui Hiroyuki, Iwasa Shizuko, Umehara Nobuhiro, Tomioka Hideyuki, Aomi Shigeyuki, Yamazaki Kenji
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2016 Oct;23(4):599-607. doi: 10.1093/icvts/ivw196. Epub 2016 Jun 23.
Heart valve replacement with a bileaflet mechanical valve is a well-established procedure. However, the long-term results of valve replacement using the bileaflet mechanical valve remain unclear, especially for follow-up periods over 30 years. Additionally, it is important to identify predictors of long-term mortality and valve-related events.
We performed a retrospective cohort analysis of 2727 patients (mean ± standard deviation age, 52.8 ± 1.6 years) who underwent valve replacement with a St. Jude Medical valve at our institute from 1978 to 2012. Data were collected using a questionnaire and chart review or physician contact. The cohort included 950 aortic valve replacements (AVRs), 1255 mitral valve replacements (MVRs) and 522 double valve replacements (DVRs). Follow-up was 91% complete, and the analysis included a total of 39 187 patient-years.
Operative mortality rates were 2.3% for AVR, 2.2% for MVR and 3.6% for DVR. The 30-year survival rate (actuarial method) was 38.0% (AVR, 44.5%; MVR, 34.9%; and DVR, 37.5%). The 30-year rates of freedom from valve-related mortality, thromboembolic events and bleeding events were 86.3% (AVR, 88.6%; MVR, 85.4%; and DVR, 84.3%), 83.5% (AVR, 89.8%; MVR, 80.0%; and DVR, 81.4%) and 91.5% (AVR, 94.4%; MVR, 90.1%; and DVR, 90.2%), respectively. The incidence rates of valve-related morbidity, thromboembolic events and bleeding events were significantly higher among patients with MVR and DVR than among those with AVR. Significant risk factors for late death and other late events included male sex, age >65 years and atrial fibrillation.
Low late mortality and a low incidence of valve-related events can be achieved for at least 30 years using mechanical bileaflet valve replacement. Persistent atrial fibrillation is a significant risk factor for morbidity and mortality.
使用双叶机械瓣膜进行心脏瓣膜置换是一种成熟的手术。然而，使用双叶机械瓣膜进行瓣膜置换的长期结果仍不明确，尤其是随访期超过30年的情况。此外，识别长期死亡率和瓣膜相关事件的预测因素很重要。
我们对1978年至2012年在我院接受圣犹达医疗瓣膜置换的2727例患者（平均年龄±标准差，52.8±1.6岁）进行了回顾性队列分析。通过问卷调查、病历审查或与医生联系收集数据。该队列包括950例主动脉瓣置换术（AVR）、1255例二尖瓣置换术（MVR）和522例双瓣膜置换术（DVR）。随访完成率为91%，分析共纳入39187患者年。
AVR的手术死亡率为2.3%，MVR为2.2%，DVR为3.6%。30年生存率（精算方法）为38.0%（AVR为44.5%；MVR为34.9%；DVR为37.5%）。30年无瓣膜相关死亡、血栓栓塞事件和出血事件的发生率分别为86.3%（AVR为88.6%；MVR为85.4%；DVR为84.3%）、83.5%（AVR为89.8%；MVR为80.0%；DVR为81.4%）和91.5%（AVR为94.4%；MVR为90.1%；DVR为90.2%）。MVR和DVR患者的瓣膜相关发病率、血栓栓塞事件和出血事件的发生率显著高于AVR患者。晚期死亡和其他晚期事件的显著危险因素包括男性、年龄>65岁和心房颤动。
使用机械双叶瓣膜置换至少30年可实现较低的晚期死亡率和较低的瓣膜相关事件发生率。持续性心房颤动是发病和死亡的重要危险因素。
