Donzeau-Gouge G P, Benomar M, Chauvaud S, Nottin R, Fabiani J N, Farge C, Gorny P, Deloche A, d'Allaines C, Blondeau P
Arch Mal Coeur Vaiss. 1985 Aug;78(8):1210-15.
Sixty-four patients with one or more bioprostheses were reoperated between 1970 and 1982. Reoperation was performed for degenerative lesions in cases (48%), for aseptic periprosthetic leaks in 18 cases (28%), for infectious lesions in 13 cases (21%) and for thrombosis in 2 cases (3%). Degenerative and infectious lesions were commoner in aortic bioprostheses whilst periprosthetic leaks were commoner in mitral bioprostheses. The average interval between operations was 38 months. This was shorter in patients reoperated for mechanical problems (6 months) than those with infections (28 months) or degenerative (5 years) complications. At reoperation 14 prostheses were reinserted and 50 were replaced. The global hospital mortality was 21% (14 deaths). The mortality was related to the surgical indication: mechanical lesions (11%), degenerative lesions (16%), infectious endocarditis (38%), thrombosis (100%). The mortality rate also varied with time (36% during the period 1970-1978 and 18% during the period 1979-1982). This improvement was related to two factors: the use of cardioplegic solutions for myocardial protection and earlier recognition of surgical indications before the onset of irreversible haemodynamic complications. When choosing a valvular prosthesis, the mortality of reoperation for degenerative changes is the only disadvantage of the bioprosthesis which is silent, rarely complicated by thromboembolism and which does not require anticoagulant therapy for life. The mortality has decreased with time and will continue to fall if the indications for reoperation are based on stethacoustic, electrical, radiological and echocardiographic criteria of valvular dysfunction and not on the presence of overt cardiac failure as is still often the case.
1970年至1982年间，64例植入一个或多个生物假体的患者接受了再次手术。再次手术的原因包括：48%的病例是由于退行性病变，18例（28%）是由于无菌性假体周围渗漏，13例（21%）是由于感染性病变，2例（3%）是由于血栓形成。退行性和感染性病变在主动脉生物假体内更为常见，而假体周围渗漏在二尖瓣生物假体内更为常见。两次手术之间的平均间隔时间为38个月。因机械问题接受再次手术的患者（6个月），其间隔时间短于因感染（28个月）或退行性病变（5年）并发症接受再次手术的患者。再次手术时，14个假体被重新植入，50个被更换。总体医院死亡率为21%（14例死亡）。死亡率与手术指征相关：机械性病变（11%）、退行性病变（16%）、感染性心内膜炎（38%）、血栓形成（100%）。死亡率也随时间变化（1970 - 1978年期间为36%，1979 - 1982年期间为18%）。这种改善与两个因素有关：使用心脏停搏液保护心肌，以及在不可逆血流动力学并发症发生之前更早地识别手术指征。在选择瓣膜假体时，因退行性改变进行再次手术的死亡率是生物假体唯一的缺点，生物假体无明显症状，很少并发血栓栓塞，且终生无需抗凝治疗。随着时间推移，死亡率有所下降，如果基于瓣膜功能障碍的听诊、电学、放射学和超声心动图标准而非仍然常见的明显心力衰竭情况来确定再次手术指征，死亡率将继续下降。
