Magilligan D J, Lewis J W, Heinzerling R H, Smith D
J Thorac Cardiovasc Surg. 1983 Mar;85(3):362-70.
Since October, 1971, 744 porcine bioprosthetic valves were inserted in patients discharged from the hospital and were therefore at risk for primary valve failure or tissue degeneration. In this period of time, 41 valves have demonstrated spontaneous degeneration. The percentages of valve survival without degeneration are as follows: at 6 yeras, 93% +/- 1.5% (SE); 7 years, 88% +/- 2.0%; 8 years, 82% +/- 2.9%; 9 years, 80% +/- 3.4%. The incidence of degeneration appears to be decreasing even though the total number of valves at risk is increasing each year. Of the 41 valves removed for spontaneous degeneration, 25 valves in 24 patients have been replaced by a second bioprosthesis. These 24 patients have been followed up for from 2 to 61 months, and there has been no clinical evidence of degeneration of the second bioprosthesis. One patient has had a second bioprosthesis longer than the first. Although others have suggested that degeneration may be immunologic event, our experience suggests that there is no "second set" rejection. The absence of a "second set" rejection and the suggestion of a decreasing incidence of degeneration makes us continue to favor the bioprosthesis for primary and secondary valve replacement.
自1971年10月以来，744个猪生物瓣膜被植入出院患者体内，因此这些患者存在原发性瓣膜失效或组织退化的风险。在此期间，有41个瓣膜出现了自发性退化。无退化的瓣膜生存率如下：6年时为93%±1.5%（标准误）；7年时为88%±2.0%；8年时为82%±2.9%；9年时为80%±3.4%。尽管每年处于风险中的瓣膜总数在增加，但退化的发生率似乎在下降。在因自发性退化而取出的41个瓣膜中，24例患者的25个瓣膜已被第二个生物瓣膜替换。这24例患者已随访2至61个月，尚无第二个生物瓣膜退化的临床证据。有1例患者使用第二个生物瓣膜的时间比第一个长。尽管其他人认为退化可能是免疫反应，但我们的经验表明不存在“二次”排斥反应。不存在“二次”排斥反应以及退化发生率下降的迹象，使我们继续倾向于使用生物瓣膜进行原发性和继发性瓣膜置换。
