Mikaeloff P, Convert G, Fleurette J, Silie M, Didierlaurent J F, Van Haecke P
Nouv Presse Med. 1981 Mar 28;10(14):1131-4.
Between 1970 and 1974, twenty-three patients with advanced multivalve lesions underwent tricuspid valve replacement with a human aortic valve allograft (26-28 mm in diameter) mounted on a Shumway ring. The mean follow-up was 76.7 months. Early post-operative mortality was 4.4% and late mortality 17.4%. The actuarial survival rate was 86.6% at 5 years and 74.2% at 8 years. In 1979, 17 out of 18 survivors (one was lost sight of) were reinvestigated by cardiologists. Late functional improvement z found in 82.2% of the cases; two patients failed to improve owing to recurrent mitral stenosis. On clinical examination 12 out of 15 subjects showed no sign of right ventricular failure. In 54% the cases phonocardiography revealed abnormal tricuspid sounds indicating variable and moderate deterioration of the allograft. Haemodynamic studies showed a significant decrease in mean right atrial pressure (p less than 0.001) and mean pulmonary artery pressure (p less than 0.001), and an increase in cardiac index (p less than 0.01). The diastolic gradient through the graft was always inferior to 3 mmHg (mean 1.2 mmHg), with little change on exercise. This was significantly less than the 3.9 mmHg gradient observed with tricuspid valve replacement using Hancok valve. These were the only tricuspid valve replacements performed in our unit in 1970-74. The satisfactory long-term results obtained contrast with the frequent deterioration observed in aortic valve replacements carried out during the same period by the same team, using the same technique
1970年至1974年间，23例患有晚期多瓣膜病变的患者接受了三尖瓣置换术，使用的是安装在Shumway环上的人主动脉瓣同种异体移植物（直径26 - 28毫米）。平均随访时间为76.7个月。术后早期死亡率为4.4%，晚期死亡率为17.4%。5年时的精算生存率为86.6%，8年时为74.2%。1979年，18名幸存者中的17名（1名失访）接受了心脏病专家的再次检查。82.2%的病例出现了晚期功能改善；两名患者因复发性二尖瓣狭窄未能改善。临床检查发现，15名受试者中有12名没有右心室衰竭的迹象。54%的病例心音图显示三尖瓣声音异常，表明同种异体移植物有不同程度的中度退化。血流动力学研究显示，平均右心房压力显著降低（p < 0.001），平均肺动脉压力显著降低（p < 0.001），心脏指数增加（p < 0.01）。通过移植物的舒张期压差始终低于3 mmHg（平均1.2 mmHg），运动时变化不大。这明显低于使用Hancok瓣膜进行三尖瓣置换术时观察到的3.9 mmHg的压差。这些是我们科室在1970 - 1974年间仅有的三尖瓣置换手术。所获得的令人满意的长期结果与同期同一团队使用相同技术进行的主动脉瓣置换术中频繁出现的退化情况形成了对比。
