Kawazoe K, Umezu M, Ohara K, Kaku K, Tomino T, Fujita T, Manabe H
Jpn Circ J. 1984 Oct;48(10):1123-9. doi: 10.1253/jcj.48.1123.
One of the major causes of postoperative morbidity and mortality after valve replacement surgery is the prosthetic valve substitute itself. In this discussion, therefore, we make a fundamental evaluation of hydrodynamic valve function and present our clinical results following valve replacement with the Björk-Shiley valve prosthesis, the Hancock porcine xenograft and the Ionescu-Shiley bovine pericardial xenograft. In an experimental study using a mechanical simulator system, the pericardial xenograft displayed superior hydrodynamic characteristics compared to other two valve substitutes. Postoperative hemodynamic evaluation further indicated that the pericardial xenograft performed significantly better than the porcine xenograft regarding transvalvular pressure gradient, effective valve area and cusp opening. In addition, data from 387 patients with aortic, mitral or both types of valve replacement who had received one of the three kinds of valve substitute were analyzed. Systemic thromboembolic complications occurred in one patient with an aortic Björk-Shiley valve (0.6% per patient-year), six with mitral Hancock xenografts (2.8% per patient-year) and one with an aortic and mitral Hancock xenograft (2.2% per patient-year). The incidence of prosthetic valve endocarditis was 0.84% per patient-year for the Hancock xenograft and 1.84% per patient-year for the Ionescu-Shiley xenograft. It was concluded that the hemodynamic and antithrombogenic advantages of the pericardial xenograft proven by our mid-term follow-up study make it the valve substitute of choice. However, careful attention is required regarding prosthetic valve endocarditis tissue heart valves, which are more susceptible to infection than mechanical ones, and the long-term durability of the pericardial xenograft remains to be confirmed.
瓣膜置换手术后发病和死亡的主要原因之一是人工瓣膜本身。因此，在本讨论中，我们对流体动力学瓣膜功能进行了基本评估，并展示了使用比约克-希利瓣膜假体、汉考克猪异种移植物和约内斯库-希利牛心包异种移植物进行瓣膜置换后的临床结果。在一项使用机械模拟器系统的实验研究中，与其他两种瓣膜替代品相比，心包异种移植物显示出更好的流体动力学特性。术后血流动力学评估进一步表明，心包异种移植物在跨瓣膜压力梯度、有效瓣膜面积和瓣叶开口方面的表现明显优于猪异种移植物。此外，对387例接受了这三种瓣膜替代品之一进行主动脉、二尖瓣或两者瓣膜置换的患者的数据进行了分析。1例植入主动脉比约克-希利瓣膜的患者发生全身性血栓栓塞并发症（每年每例患者发生率为0.6%），6例植入二尖瓣汉考克异种移植物的患者发生该并发症（每年每例患者发生率为2.8%），1例植入主动脉和二尖瓣汉考克异种移植物的患者发生该并发症（每年每例患者发生率为2.2%）。汉考克异种移植物的人工瓣膜心内膜炎发生率为每年每例患者0.84%，约内斯库-希利异种移植物为每年每例患者1.84%。结论是，我们的中期随访研究证明心包异种移植物在血流动力学和抗血栓形成方面的优势使其成为首选的瓣膜替代品。然而，对于人工瓣膜心内膜炎，需要特别关注组织心脏瓣膜，它们比机械瓣膜更容易感染，并且心包异种移植物的长期耐久性仍有待证实。
