Péterffy A, Henze A, Jonasson R, Björk V O
Scand J Thorac Cardiovasc Surg. 1978;12(3):179-87.
Tricuspid valve replacement with the Björk-Shiley tilting disc valve was performed in 61 consecutive patients with either organic disease causing valve malfunction or functional regurgitation of severe degree. The early mortality rate was 21% (13/61) for the entire series. It was 10% (1/10) for tricuspid valve replacement alone, 27% (9/33) for mitral and tricuspid valve replacement, and 18% (3/17) for triple valve replacement. Age over 60 years, functional capacity group IV (N.Y.H.A.) and heart volume over 900 ml/m2 BSA were factors associated with a high operative mortality. There were 3 late deaths, 42, 42 and 45 months, respectively, after surgery, due to arrhythmia (2) and anticoagulant complications (1). The Björk-Shiley prosthesis has functioned well and with satisfactory clinical improvement in the majority of the 48 long-term survivors, for an average period of 2.8 years. There were, however, 3 cases of prosthetic valve failure due to thrombotic obstruction following isolated tricuspid replacement because of Ebstein's anomaly (2) and traumatic tricuspid valvular incompetence (1). Reoperation with insertion of a new Björk-Shiley prosthesis involved no mortality. One patient, however, had a recurrent prosthetic thrombosis which was successfully treated with streptokinase. Only one patient in the series, who underwent triple valve replacement, suffered from systemic embolism, an incidence of 0.7 per 100 patient years. There were no episodes of pulmonary embolism or infective endocarditis.
对61例因器质性疾病导致瓣膜功能障碍或重度功能性反流的患者连续进行了Björk-Shiley倾斜盘式瓣膜三尖瓣置换术。整个系列的早期死亡率为21%（13/61）。单纯三尖瓣置换术的死亡率为10%（1/10），二尖瓣和三尖瓣置换术的死亡率为27%（9/33），三瓣膜置换术的死亡率为18%（3/17）。年龄超过60岁、纽约心脏协会（N.Y.H.A.）心功能IV级和心脏容积超过900 ml/m²体表面积是与高手术死亡率相关的因素。术后分别在42、42和45个月有3例晚期死亡，原因是心律失常（2例）和抗凝并发症（1例）。在48例长期存活者中，大多数患者的Björk-Shiley人工瓣膜功能良好，临床改善令人满意，平均随访时间为2.8年。然而，由于埃布斯坦畸形（2例）和创伤性三尖瓣关闭不全（1例）导致孤立性三尖瓣置换术后有3例人工瓣膜因血栓阻塞而功能障碍。再次手术植入新的Björk-Shiley人工瓣膜未导致死亡。然而，有1例患者人工瓣膜反复发生血栓形成，经链激酶成功治疗。该系列中只有1例接受三瓣膜置换术的患者发生了全身性栓塞，发生率为每100患者年0.7例。未发生肺栓塞或感染性心内膜炎事件。
