Fuster V, Pumphrey C W, McGoon M D, Chesebro J H, Pluth J R, McGoon D C
Circulation. 1982 Aug;66(2 Pt 2):I157-61.
Our study comprised 302 consecutive patients seen between 1962 and 1971 who underwent mitral (MVR) (132 patients) or aortic valve replacement (AVR) (170 patients) with a Starr-Edwards prosthesis because of advanced mitral or aortic incompetence. The follow-up interval was 10-19 years. For more recent valve models (1200/1260 aortic or 6120/6310 mitral), the probability of a surviving patient remaining free of systemic thromboembolism after 10 years was 70% for MVR and 74% for AVR. The probability of freedom from thromboembolism was less than this for the earlier valve models; the probability for the entire group at 10 years was 66% and at 15 years was 58%, with no significant difference between AVR and MVR. About one-fourth of the patients with an embolism (20% MVR, 27% AVR) had more than one embolic event. Of all emboli, most (86% MVR, 84% AVR) were cerebral, about half (48% MVR, 57% AVR) left a neurologic deficit, and about one-tenth (11% MVR, 10% AVR) led to death. Of the predictive factors reviewed, the incidence of emboli was significantly higher only in patients with MVR considered to have inadequate anticoagulation (p less than 0.01) and in patients receiving model 6000 mitral prosthesis (p less than 0.02). This long-term follow-up study of patients with a Starr-Edwards prosthesis reveals that systemic embolism is a persistent and significant problem.
我们的研究纳入了1962年至1971年间连续就诊的302例患者，这些患者因严重二尖瓣或主动脉瓣关闭不全，接受了使用斯塔尔-爱德华兹人工瓣膜的二尖瓣置换术（MVR）（132例患者）或主动脉瓣置换术（AVR）（170例患者）。随访时间为10至19年。对于较新的瓣膜型号（1200/1260型主动脉瓣或6120/6310型二尖瓣），存活患者在10年后无全身性血栓栓塞的概率，MVR为70%，AVR为74%。早期瓣膜型号的无血栓栓塞概率低于此；整个组在10年时的概率为66%，在15年时为58%，AVR和MVR之间无显著差异。约四分之一发生栓塞的患者（MVR为20%，AVR为27%）有不止一次栓塞事件。在所有栓塞中，大多数（MVR为86%，AVR为84%）为脑栓塞，约一半（MVR为48%，AVR为57%）遗留神经功能缺损，约十分之一（MVR为11%，AVR为10%）导致死亡。在审查的预测因素中，仅在被认为抗凝不足的MVR患者（p<0.01）和接受6000型二尖瓣人工瓣膜的患者（p<0.02）中，栓塞发生率显著更高。这项对使用斯塔尔-爱德华兹人工瓣膜患者的长期随访研究表明，全身性栓塞是一个持续且严重的问题。
