Borst H G, Frank G, Frimpong-Boateng K, Bednarski P
Z Kardiol. 1986 Jun;75(6):311-5.
Improvement of materials, prosthetic function and perioperative treatment has led to positive results with regard to life expectancy, quality of life and complication rates in heart valve replacement. While mechanical valves are still associated with the risks of thromboembolism and anticoagulant bleeding, there is a continuing risk of early valve dysfunction in bioprostheses. We have preferred the latter during the last 8 years; however, certain disadvantages have become obvious during the follow-up of a group of 132 patients beyond the 6th postoperative year. Anticoagulant treatment has been withheld in some patients in spite of a clear indication while others have received coumadin in the absence of obvious reasons. Valve degeneration as discovered by echocardiography often was not recognized in time, resulting in a significant reoperative mortality. As a result the indication for biological valve replacement, especially in the mitral position, has become more restrictive in our hands.
材料、假体功能及围手术期治疗的改善，已在心脏瓣膜置换的预期寿命、生活质量及并发症发生率方面带来了积极成果。虽然机械瓣膜仍与血栓栓塞和抗凝出血风险相关，但生物假体存在早期瓣膜功能障碍的持续风险。在过去8年里我们更倾向于使用生物假体；然而，在一组132例患者术后6年以上的随访中，某些缺点已变得明显。尽管有明确指征，一些患者仍未接受抗凝治疗，而另一些患者在没有明显原因的情况下接受了香豆素治疗。超声心动图发现的瓣膜退变往往未得到及时识别，导致再次手术死亡率显著升高。因此，在我们看来，生物瓣膜置换的指征，尤其是二尖瓣位置的置换指征，已变得更加严格。
