Martinell J, Fraile J, Artiz V, Cortina J, Fresneda P, Rábago G
Ann Thorac Surg. 1987 Feb;43(2):172-5. doi: 10.1016/s0003-4975(10)60390-6.
A series of 2,474 hospital survivors of primary mitral, aortic, and double mitral-aortic valve replacement were observed for a cumulative period of 11.945 years (mean, 4.2 years; range, 0.6-14 years). The linearized incidences of reoperations for thrombotic obstructions were 0.33 +/- 0.08% for mitral valve replacement, 0.36 +/- 0.1% for aortic valve replacement, and 0.42 +/- 0.1% for double valve replacement (p = not significant). Forty-one patients (16 mitral, 12 aortic, and 13 double valve replacements) underwent a total of 44 reoperations with a mean interval of 36 +/- 29 months (range, 0.25-85 months) between operations. Diagnosis was established invasively only in 13 patients (30%). Hospital mortality at reoperation was 18% (8 patients); 28 patients (63%) required emergency surgery. The choice surgical procedures were thrombectomy for clotted aortic prostheses (18 of 24) and valve replacement for obstructed mitral valves (22 of 25; p less than .001). Rethrombosis occurred in 3 patients (1 aortic and 2 double valve replacements). At hospital admission 17 patients (38%) had prothrombin times outside therapeutic ranges (between 20 to 30% of the normal value). The incidence of reoperations for thrombosis in low-profile mechanical prostheses was unaffected by valvar position and number of prostheses implanted. Rethrombosis occurred only in previously cleaned valves, although its occurrence was not significant. The present results indicate that, as experience is gained in the diagnosis and surgical management of this complication, hospital mortality can be reduced significantly (from 37% to 4%).
对2474例接受原发性二尖瓣、主动脉瓣及二尖瓣-主动脉瓣联合置换术的医院幸存者进行了一系列观察，累计观察时间为11.945年（平均4.2年；范围0.6 - 14年）。二尖瓣置换术后血栓形成梗阻再次手术的线性化发生率为0.33±0.08%，主动脉瓣置换术后为0.36±0.1%，双瓣置换术后为0.42±0.1%（p =无显著性差异）。41例患者（16例二尖瓣置换、12例主动脉瓣置换和13例双瓣置换）共接受了44次再次手术，两次手术之间的平均间隔为36±29个月（范围0.25 - 85个月）。仅13例患者（30%）通过侵入性检查确诊。再次手术时的医院死亡率为18%（8例患者）；28例患者（63%）需要急诊手术。选择的手术方式为对血栓形成的主动脉人工瓣膜进行血栓切除术（24例中的18例），对梗阻的二尖瓣进行瓣膜置换术（25例中的22例；p<0.001）。3例患者（1例主动脉瓣置换和2例双瓣置换）发生再血栓形成。入院时17例患者（38%）的凝血酶原时间超出治疗范围（在正常值的20%至30%之间）。低瓣架机械瓣膜血栓形成再次手术的发生率不受瓣膜位置和植入瓣膜数量的影响。再血栓形成仅发生在先前清洁过的瓣膜中，但其发生率无显著性差异。目前的结果表明，随着对该并发症诊断和手术管理经验的积累，医院死亡率可显著降低（从37%降至4%）。
