Ribeiro P A, Al Zaibag M, Idris M, Al Kasab S, Davies G, Mashat E, Wareham E, Al Fagih M
J Thorac Cardiovasc Surg. 1986 Jan;91(1):92-8.
The incidence of thromboembolic complications after St Jude Medical aortic valve replacement was evaluated in patients who received antiplatelet drugs alone (aspirin and dipyridamole). This report includes 107 consecutive patients undergoing aortic valve replacement with the St. Jude Medical prosthesis from February, 1980, until December, 1983. There were three perioperative deaths (2.8%). Thirty-seven of these patients received life-time warfarin anticoagulation and therefore were excluded from further analysis. The remaining 67 patients receiving antiplatelet drugs were followed up for 22 +/- 8 months (range 5 to 54 months) with a total observation period of 123 patient-years. Group 1 consisted of 52 patients having single St. Jude Medical aortic valve replacement (mean age 27 +/- 10 years). Group 2 included 15 patients having St. Jude Medical aortic valve replacement with additional mitral valve replacement (mean age 27 +/- 11 years). There were no postoperative embolic events in Group 1, but two St. Jude Medical aortic prostheses became thrombotic (2.1 per 100 patient-years) 19 and 32 months after the operation. Emergency aortic valve replacement was done in one of these patients and aortic thrombectomy in the other. Both patients are alive and doing well. In Group 2, three patients (10 per 100 patients-years) had thrombosis of the St. Jude Medical aortic valve 10, 12, and 30 months after the operation, and two of them required emergency aortic value replacement. One of these patients also had a massive left coronary embolus and could not be weaned from cardiopulmonary bypass. The third patient, who was asymptomatic, was prescribed warfarin anticoagulation and has been well. None of the seven patients in this group with St. Jude Medical aortic and mitral prostheses has had a thromboembolic event. These results indicate that antiplatelet drugs alone are associated with a very low risk of embolism but are insufficient to prevent thrombosis of St. Jude Medical aortic valves, even when the patients have sinus rhythm.
对仅接受抗血小板药物（阿司匹林和双嘧达莫）治疗的患者，评估了圣犹达医疗公司主动脉瓣置换术后血栓栓塞并发症的发生率。本报告纳入了1980年2月至1983年12月期间连续107例行圣犹达医疗公司人工主动脉瓣置换术的患者。围手术期死亡3例（2.8%）。其中37例患者接受了终身华法林抗凝治疗，因此被排除在进一步分析之外。其余67例接受抗血小板药物治疗的患者随访了22±8个月（范围5至54个月），总观察期为123患者年。第1组由52例单纯行圣犹达医疗公司主动脉瓣置换术的患者组成（平均年龄27±10岁）。第2组包括15例在圣犹达医疗公司主动脉瓣置换术基础上还接受二尖瓣置换术的患者（平均年龄27±11岁）。第1组术后无栓塞事件发生，但有2个圣犹达医疗公司主动脉人工瓣膜在术后19个月和32个月发生血栓形成（每100患者年2.1例）。其中1例患者接受了急诊主动脉瓣置换术，另1例接受了主动脉血栓切除术。2例患者均存活且情况良好。在第2组中，3例患者（每100患者年10例）在术后10个月、12个月和30个月发生圣犹达医疗公司主动脉瓣血栓形成，其中2例需要急诊主动脉瓣置换术。其中1例患者还发生了巨大的左冠状动脉栓塞，无法脱离体外循环。第3例患者无症状，接受了华法林抗凝治疗，情况良好。该组7例同时植入圣犹达医疗公司主动脉瓣和二尖瓣人工瓣膜的患者均未发生血栓栓塞事件。这些结果表明，仅使用抗血小板药物时栓塞风险非常低，但不足以预防圣犹达医疗公司主动脉瓣血栓形成，即使患者为窦性心律。
