Borkon A M, Soule L M, Baughman K L, Baumgartner W A, Gardner T J, Watkins L, Gott V L, Hall K A, Reitz B A
Division of Cardiac Surgery and Cardiology, Johns Hopkins Hospital, Baltimore, MD.
Ann Thorac Surg. 1988 Sep;46(3):270-7. doi: 10.1016/s0003-4975(10)65924-3.
To determine the influence of valve selection on valve-related morbidity and mortality and patient survival, comparative long-term performance characteristics of mechanical (N = 68) and bioprosthetic (N = 73) heart valves were analyzed for 141 patients more than 70 years old who underwent isolated aortic valve replacement between 1970 and 1985. Cumulative patient follow-up was 491 patient-years (average, 4.3 years per patient). Hospital mortality was 18% and 19% for patients with mechanical valves and bioprosthetic valves, respectively. Survival at 5 years was 61 +/- 7% (+/- the standard error) and 67 +/- 10% for recipients of mechanical valves and bioprosthetic valves, respectively. Male sex (p = 0.014) and urgency of operation (p = 0.006) were independent risk factors for hospital mortality. Atrial fibrillation increased valve-related mortality (p = 0.01). No patient required reoperation or experienced structural valve failure. While anticoagulant-related hemorrhage was increased in recipients of mechanical valves (9.2 +/- 2.1%/patient-year) compared with recipients of bioprosthetic valves (2.3 +/- 1.1%/patient-year), it did not result in a death or lead to permanent disability. There was no difference in freedom from any valve-related complication at 5 years. However, when all morbid events are considered, recipients of bioprosthetic valves experienced fewer valve-related complications than patients receiving mechanical valves (10.7 +/- 2.3%/patient-year versus 17.6 +/- 2.5%/patient-year, respectively; p less than 0.05). The reduced incidence of anticoagulant-related hemorrhage and the infrequent need for warfarin sodium anticoagulation favor selection of a bioprosthetic heart valve in patients older than 70 years.
为确定瓣膜选择对瓣膜相关发病率、死亡率及患者生存率的影响，对1970年至1985年间接受单纯主动脉瓣置换术的141例70岁以上患者的机械瓣膜（N = 68）和生物瓣膜（N = 73）的长期性能特征进行了比较分析。患者累计随访时间为491患者年（平均每位患者4.3年）。机械瓣膜患者和生物瓣膜患者的医院死亡率分别为18%和19%。机械瓣膜和生物瓣膜接受者的5年生存率分别为61±7%（±标准误差）和67±10%。男性（p = 0.014）和手术紧迫性（p = 0.006）是医院死亡率的独立危险因素。房颤增加了瓣膜相关死亡率（p = 0.01）。没有患者需要再次手术或发生瓣膜结构故障。与生物瓣膜接受者（2.3±1.1%/患者年）相比，机械瓣膜接受者的抗凝相关出血有所增加（9.2±2.1%/患者年），但未导致死亡或永久性残疾。5年时在无任何瓣膜相关并发症方面没有差异。然而，当考虑所有不良事件时，生物瓣膜接受者比接受机械瓣膜的患者经历的瓣膜相关并发症更少（分别为10.7±2.3%/患者年和17.6±2.5%/患者年；p＜0.05）。抗凝相关出血发生率的降低以及华法林钠抗凝需求的减少有利于70岁以上患者选择生物心脏瓣膜。
