Brais M P, Bédard J P, Goldstein W, Koshal A, Keon W J
Can J Surg. 1985 Mar;28(2):119-21, 123.
From February 1976 to May 1981 at the University of Ottawa Heart Institute, 137 mitral valves were replaced with the Hancock porcine bioprosthesis. This study concerns 111 patients (55 men, 56 women) who had single-valve replacement. The average age of the patients was 53.0 years. The predominant lesion in the 102 patients who were receiving their first substitute valve was stenosis in 46% and regurgitation in 42%. Preoperatively, 82% were New York Heart Association (NYHA) class III or IV. Additional procedures were performed in 44 patients (39.6%). The 26 patients who had multiple valves replaced were considered only for durability studies. Hospital mortality was 8.9% for isolated replacement and 22% for replacement associated with aortocoronary bypass grafting. At the time of discharge, 50% of patients were in atrial fibrillation, 14% were taking warfarin and 82% antiplatelet agents. Follow-up was available for a total of 374 patient-years (average of 5.4 years per patient). The mean symptomatic improvement was 1.6 NYHA classes per patient. Actuarial analysis indicated a survival rate of 70% at 8 years. Of the 18 late deaths, 4 (22%) were valve-related. The rates of endocarditis and thromboembolism were 1.1% and 5.8% patient-year respectively. In the 137 prostheses at risk, intrinsic failure occurred at the rate of 4.7% patient-year for a cumulative rate of 35% at 8 years. The authors conclude that the Hancock porcine bioprosthesis provides good relief of symptoms in the mitral position with an acceptable rate of thromboembolism even without anticoagulation.(ABSTRACT TRUNCATED AT 250 WORDS)
1976年2月至1981年5月期间，渥太华大学心脏研究所对137例患者进行了二尖瓣置换手术，使用的是汉考克猪生物瓣膜。本研究涉及111例接受单瓣膜置换的患者（55例男性，56例女性）。患者的平均年龄为53.0岁。在102例首次接受瓣膜置换的患者中，主要病变为狭窄的占46%，反流的占42%。术前，82%的患者为纽约心脏协会（NYHA）III级或IV级。44例患者（39.6%）还接受了其他手术。26例接受多瓣膜置换的患者仅纳入耐久性研究。单纯瓣膜置换的医院死亡率为8.9%，与主动脉冠状动脉搭桥术联合置换的死亡率为22%。出院时，50%的患者处于房颤状态，14%的患者服用华法林，82%的患者服用抗血小板药物。总的随访时间为374患者年（平均每位患者5.4年）。每位患者症状改善的平均程度为1.6个NYHA级别。精算分析表明，8年生存率为70%。在18例晚期死亡病例中，4例（22%）与瓣膜相关。心内膜炎和血栓栓塞的发生率分别为每年1.1%和5.8%。在137个有风险的人工瓣膜中，内在失效的发生率为每年4.7%，8年累计发生率为35%。作者得出结论，汉考克猪生物瓣膜能有效缓解二尖瓣病变患者的症状，即使不进行抗凝，血栓栓塞发生率也在可接受范围内。（摘要截选至250词）
