不同型号机械和生物二尖瓣假体的长期随访

Long-term follow-up of different models of mechanical and biological mitral prostheses.

作者信息

Vitale N, Giannolo B, Nappi G A, de Luca L, Piazza L, Scardone M, Cotrufo M

机构信息

Institute of Cardiac Surgery, Medical School, Monaldi Hospital, Naples, Italy.

出版信息

Eur J Cardiothorac Surg. 1995;9(4):181-9. doi: 10.1016/s1010-7940(05)80142-3.

DOI:10.1016/s1010-7940(05)80142-3

PMID:7605641

Abstract

Three hundred eighty-five valve prostheses were implanted between 1974 and 1981 in patients with isolated mitral disease: 157 caged-ball valves (156 Starr-Edwards; 1 Smeloff-Cutter) (group A), 107 tilting-disc valves (44 Bjork-Shiley, 49 Sorin, 14 Lillehei-Kaster) (group B), 121 porcine bioprostheses (45 Carpentier-Edwards, 66 Liotta, 10 Hancock) (group C). Perioperative mortality was 9.5% in group A, 11.2% in group B and 6.6% in group C. The follow-up was 86% complete. Actuarial freedom from complications was calculated as follows (linearised rates in brackets) in groups A, B and C, respectively: survival: 47.01% +/- 0.11 (3% patient/yr), 53.37% +/- 0.08 (1.8% patient/yr), 61.24% +/- 0.05 (2.2% patient/yr); thromboembolism: 67.94% +/- 0.09 (1.18% patient/yr); 73.07% +/- 0.06 (1% patient/yr); 97.43% +/- 0.02 (0.02% patient/yr); anticoagulation-related hemorrhage: 84.10% +/- 0.13 (0.18% patient/yr), 97.21% +/- 0.01 (0.12% patient/yr), 100%; prosthetic valve endocarditis: 100% in groups A and B, 95.76% +/- 0.02 (0.18% patient/yr) in group C; valve-related mortality: 87.52% +/- 0.03 (0.75% patient/yr), 87.96% +/- 0.03 (0.56% patient/yr), 82.53% +/- 0.04 (0.93% patient/yr); valve failure: 81.22% +/- 0.07 (0.56% patient/yr), 63.36% +/- 0.1 (1.06% patient/yr), 14.31% +/- 0.05 (4% patient/yr); treatment failure: 78.81% +/- 0.05 (1.12% patient/yr), 76.44% +/- 0.09 (0.62% patient/yr), 80.97% +/- 0.04 (1% patient/yr); all valve-related morbidity and mortality: 40.43% +/- 0.13 (1.93% patient/yr), 57.76% +/- 0.08 (1.43% patient/yr), 14.96% +/- 0.05 (4.18% patient/yr); all valve-related morbidity and mortality at 5 years: 91.97% +/- 0.02 (7.8% patient/yr), 87.06% +/- 0.03 (3.6% patient/yr), 90.27% +/- 0.03 (2.6% patient/yr); at 10 years: 80.4% +/- 0.03 (4.6% patient/yr), 75.91% +/- 0.03 (2.6% patient/yr), 37.44% +/- 0.05 (4.18% patient/yr).(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

1974年至1981年间，385个瓣膜假体被植入单纯二尖瓣疾病患者体内：157个笼球瓣（156个斯塔尔-爱德华兹瓣；1个斯梅洛夫-卡特瓣）（A组），107个倾斜碟瓣（44个比约克-希利瓣，49个索林瓣，14个利尔黑-卡斯特瓣）（B组），121个猪生物瓣（45个卡彭蒂埃-爱德华兹瓣，66个利奥塔瓣，10个汉考克瓣）（C组）。A组围手术期死亡率为9.5%，B组为11.2%，C组为6.6%。随访完成率为86%。A、B、C组无并发症的精算自由度计算如下（括号内为线性化率）：生存率：47.01%±0.11（3%患者/年），53.37%±0.08（1.8%患者/年），61.24%±0.05（2.2%患者/年）；血栓栓塞：67.94%±0.09（1.18%患者/年）；73.07%±0.06（1%患者/年）；97.43%±0.02（0.02%患者/年）；抗凝相关出血：84.10%±0.13（0.18%患者/年），97.21%±0.01（0.12%患者/年），100%；人工瓣膜心内膜炎：A组和B组为100%，C组为95.76%±0.02（0.18%患者/年）；瓣膜相关死亡率：87.52%±0.03（0.75%患者/年），87.96%±0.03（0.56%患者/年），82.53%±0.04（0.93%患者/年）；瓣膜失效：81.22%±0.07（0.56%患者/年），63.36%±0.1（1.06%患者/年），14.31%±0.05（4%患者/年）；治疗失败：78.81%±0.05（1.12%患者/年），76.44%±0.09（0.62%患者/年），80.97%±0.04（1%患者/年）；所有瓣膜相关的发病率和死亡率：40.43%±0.13（1.93%患者/年），57.76%±0.08（1.43%患者/年），14.96%±0.05（4.18%患者/年）；5年时所有瓣膜相关的发病率和死亡率：91.97%±0.02（7.8%患者/年），87.06%±0.03（3.6%患者/年），90.27%±0.03（2.6%患者/年）；10年时：80.4%±0.03（4.6%患者/年），75.91%±0.03（2.6%患者/年），37.44%±0.05（4.18%患者/年）。（摘要截断于250字）