Starr D S, Lawrie G M, Howell J F, Morris G C
Ann Thorac Surg. 1980 Nov;30(5):448-54. doi: 10.1016/s0003-4975(10)61296-9.
To determine the long-term results of aortic valve replacement with the Smeloff-Cutter prosthesis, the fate of 358 of 459 (78%) consecutive patients was determined 1 to 12 years postoperatively. There were 319 male patients (70%). Mean age at operation was 57 years (range, 15 to 84 years). Aortic stenosis was the dominant lesion in 267 patients (58%) and aortic regurgitation in 133 patients (29%). Fifty-nine patients (13%) had both aortic stenosis and regurgitation. In addition to aortic valve replacement, 93 patients (20%) had coronary artery bypass, 30 (6.5%) had mitral commissurotomy, 23 (5%) had mitral valve replacement, and 41 (9%) had other procedures. Preoperative status by New York Heart Association Functional Class was: Class I, 3 (1%); Class II, 39 (8%); Class III, 148 (32%); and Class IV, 269 (59%). Operative (30-day) mortality was 8.5% (39 out of 459). Functional improvement was obtained in all postoperative survivors: 345 (82%), Class I; 63 (15%), Class II; and 12 (3%), Class III. A perivalvular leak developed in 6 patients (1%) and subacute bacterial endocarditis in five (1%). Actuarial long-term survival was 80% at 5 years and 71% at 8 years. Thromboembolism occurred in 34 patients (9.5%). The incidence of thromboembolism per 100 patient-years for patients receiving no anticoagulants was 5.4; antiplatelet agents, 2.9; and Coumadin (sodium warfarin), 2.6. Major thromboembolism was uncommon in patients on a regimen of sodium warfarin but major morbidity from bleeding was significant.
为了确定采用斯梅洛夫-卡特人工心脏瓣膜进行主动脉瓣置换术的长期效果，对连续459例患者中的358例（78%）在术后1至12年的转归情况进行了评估。其中男性患者319例（70%）。手术时的平均年龄为57岁（范围15至84岁）。267例患者（58%）以主动脉瓣狭窄为主要病变，133例患者（29%）以主动脉瓣关闭不全为主要病变。59例患者（13%）同时存在主动脉瓣狭窄和关闭不全。除主动脉瓣置换术外，93例患者（20%）接受了冠状动脉搭桥术，30例（6.5%）接受了二尖瓣交界切开术，23例（5%）接受了二尖瓣置换术，41例（9%）接受了其他手术。根据纽约心脏协会心功能分级，术前状态为：I级，3例（1%）；II级，39例（8%）；III级，148例（32%）；IV级，269例（59%）。手术（30天）死亡率为8.5%（459例中有39例）。所有术后存活患者的心功能均有改善：I级345例（82%）；II级63例（15%）；III级12例（3%）。6例患者（1%）出现瓣周漏，5例患者（1%）发生亚急性细菌性心内膜炎。5年时的精算长期生存率为80%，8年时为71%。34例患者（9.5%）发生血栓栓塞。未接受抗凝治疗的患者每100患者年的血栓栓塞发生率为5.4；接受抗血小板药物治疗的患者为2.9；接受华法林（华法林钠）治疗的患者为2.6。接受华法林钠治疗方案的患者中，严重血栓栓塞并不常见，但出血导致的严重发病率却很显著。
