Lindblom D
Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
J Thorac Cardiovasc Surg. 1988 Apr;95(4):658-67.
The results of 1753 consecutive aortic valve replacements performed during a 15-year period (1969 to June 1983) are reported. All patients received one of five models of the Björk-Shiley valve. The follow-up was 99.6% complete and covered 10,658 patient-years (mean 6.4 years). An autopsy was performed in 72% of all fatalities. Early mortality was 5.5%. The early mortality rate for patients undergoing isolated, elective aortic valve replacement between 1979 and 1983 was 2.3%. Five-, 10-, and 15-year actuarial survival rates (early mortality excluded) were 85%, 70%, and 54%, respectively, and complication-free survival rates at the same time intervals were 78%, 59%, and 42%. Eighteen percent of the late deaths were considered valve related. Anticoagulant-related hemorrhage was the single most common valve-related complication (1.4/100 patient-years) and the most common valve-related cause of death (0.3/100 patient-years). The incidences of embolism and valve thrombosis were closely related to the efficacy of the anticoagulant program. Fourteen of 19 valve thromboses occurred among 180 patients without anticoagulants. The incidences of embolism and valve thrombosis among 1573 patients with continuous anticoagulant treatment were 0.7 and 0.06/100 patient-years, respectively. Six strut fractures occurred, all in convexo-concave valves. There was no mechanical failure among the Monostrut valves. The incidence of "prosthetic failure" (ie, valve-related complications [not leakage] necessitating reoperation or causing the patient's death) was 0.6/100 patient-years. The incidence of embolism and prosthetic failure was similar for the different valve models, and these long-term results might therefore be considered representative for all Björk-Shiley aortic valves.
本文报告了1969年至1983年6月这15年间连续进行的1753例主动脉瓣置换术的结果。所有患者均接受了五种型号之一的 Björk-Shiley 瓣膜。随访完成率为99.6%，涵盖10658患者年（平均6.4年）。所有死亡病例中有72%进行了尸检。早期死亡率为5.5%。1979年至1983年间接受单纯择期主动脉瓣置换术患者的早期死亡率为2.3%。排除早期死亡后，5年、10年和15年的精算生存率分别为85%、70%和54%，同时期无并发症生存率分别为78%、59%和42%。18%的晚期死亡被认为与瓣膜相关。抗凝相关出血是最常见的瓣膜相关并发症（1.4/100患者年），也是最常见的瓣膜相关死亡原因（0.3/100患者年）。栓塞和瓣膜血栓形成的发生率与抗凝方案的效果密切相关。19例瓣膜血栓形成中有14例发生在180例未接受抗凝治疗的患者中。1573例接受持续抗凝治疗患者的栓塞和瓣膜血栓形成发生率分别为0.7和0.06/100患者年。发生了6例支柱骨折，均发生在凸凹型瓣膜中。单支柱瓣膜未发生机械故障。“人工瓣膜故障”（即需要再次手术或导致患者死亡的瓣膜相关并发症[非渗漏]）的发生率为0.6/100患者年。不同瓣膜型号的栓塞和人工瓣膜故障发生率相似，因此这些长期结果可被视为所有 Björk-Shiley 主动脉瓣的代表性结果。
