Horstkotte D, Körfer R, Budde T, Haerten K, Schulte H D, Bircks W, Loogen F
Z Kardiol. 1983 May;72(5):251-61.
Valve-related complications after Björk-Shiley mitral (n = 475), aortic (n = 424), or mitral-aortic implantation (n = 119) were compared to complications after St. Jude mitral (n = 173), aortic (n = 152), and St. Jude mitral and aortic (n = 63) replacements. The 1,018 consecutive patients with Björk-Shiley valves had been operated upon between 1974 and 1982, those with St. Jude valves between 1978 and 1982. All patients were placed on anticoagulant therapy with phenprocoumon early after operation and no significant intergroup differences in the effectiveness of the anticoagulant therapy were found. At a comparable follow-up time of approximately 23 months, 24 major thromboembolic episodes were observed after Björk-Shiley mitral (BSM) and 3 after St. Jude mitral valve implantation (SJM), corresponding to a thromboembolic rate of 2.82/100 patient years with BSM and 0.93/100 patient years with SJM. After aortic valve replacements, 1.93 events in 100 patient years occurred after Björk-Shiley aortic (BSA) and 0.73 after St. Jude aortic implantation (SJA). In patients with double valve replacements, these rates were 3.2 (BSM + BSA) and 0.88 (SJM + SJA), respectively. The cerebral vessels were involved in 52% and the arteries of the extremities in 22% of these major events. Six Björk-Shiley prostheses had to be replaced because of valve thrombosis. The overall incidence of severe hemorrhagic complications was 2.94/100 patient years in BSM and 1.79 in SJM. After aortic valve replacement, we found rates of 1.80/100 patient years (BSA) and 2.57/100 patient years (SJA), respectively. Intravascular hemolysis no longer seems to be a significant clinical problem. However, indications of red cell damage after heart valve replacement were significantly greater in patients with perivalvular leakage, valve thrombosis, or dysfunction than in those with normally functioning prostheses. Reoperations were necessary because of valve thrombosis (0.46%), perivalvular leakage (2.2%), or prosthetic valve endocarditis with concomitant perivalvular regurgitation (0.46%). One valve had to be replaced because of fracture of the outlet strut of a BSM prosthesis. Hemorrhage due to the anticoagulant treatment was thus the most frequent complication, without significant intergroup differences, while thromboembolic complications were significantly more frequent after Björk-Shiley mitral, aortic, and double valve replacements than after St. Jude implantation. This may lead to the consideration of a change in the prophylaxis of thrombus formations with the St. Jude valve, especially in aortic valve replacements with sinus rhythm.
将接受比约克-希利二尖瓣置换术（n = 475）、主动脉瓣置换术（n = 424）或二尖瓣-主动脉瓣联合置换术（n = 119）后的瓣膜相关并发症，与接受圣犹达二尖瓣置换术（n = 173）、主动脉瓣置换术（n = 152）以及圣犹达二尖瓣和主动脉瓣联合置换术（n = 63）后的并发症进行了比较。1018例连续接受比约克-希利瓣膜置换术的患者于1974年至1982年间接受手术，接受圣犹达瓣膜置换术的患者于1978年至1982年间接受手术。所有患者术后早期均接受苯丙香豆素抗凝治疗，未发现抗凝治疗效果在组间存在显著差异。在约23个月的可比随访时间内，比约克-希利二尖瓣置换术（BSM）后观察到24例主要血栓栓塞事件，圣犹达二尖瓣置换术（SJM）后观察到3例，BSM的血栓栓塞率为2.82/100患者年，SJM为0.93/100患者年。主动脉瓣置换术后，比约克-希利主动脉瓣置换术（BSA）后每100患者年发生1.93例事件，圣犹达主动脉瓣置换术（SJA）后为0.73例。在双瓣膜置换患者中，这些发生率分别为3.2（BSM + BSA）和0.88（SJM + SJA）。这些主要事件中，52%累及脑血管，22%累及四肢动脉。6个比约克-希利人工瓣膜因瓣膜血栓形成而不得不更换。严重出血并发症的总发生率在BSM为2.94/100患者年，在SJM为1.79/100患者年。主动脉瓣置换术后，分别为1.80/100患者年（BSA）和2.57/100患者年（SJA）。血管内溶血似乎不再是一个显著的临床问题。然而，心脏瓣膜置换术后红细胞损伤的迹象在存在瓣周漏、瓣膜血栓形成或功能障碍的患者中比在人工瓣膜功能正常的患者中明显更严重。因瓣膜血栓形成（0.46%）、瓣周漏（2.2%）或人工瓣膜心内膜炎伴瓣周反流（0.46%）而需要再次手术。1个瓣膜因BSM人工瓣膜出口支柱骨折而不得不更换。因此，抗凝治疗导致的出血是最常见的并发症，组间无显著差异，而比约克-希利二尖瓣、主动脉瓣和双瓣膜置换术后血栓栓塞并发症比圣犹达瓣膜置换术后明显更频繁。这可能导致考虑改变圣犹达瓣膜血栓形成的预防措施，尤其是在窦性心律的主动脉瓣置换术中。
