Abe T, Morishita K, Tsukamoto M, Tanaka T, Komatsu S
Second Department of Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan.
Surg Today. 1995;25(3):226-32. doi: 10.1007/BF00311532.
We present herein a review of 95 patients who underwent valve replacement with the CarboMedics (CM) valve prosthesis between April 1990 and December 1992. The operative mortality for the entire group was 4.2%: 0% following aortic valve replacement (AVR), 2.7% following double valve replacement (DVR). All patients were prescribed warfarin and bucolome for anticoagulation, and were followed up for a mean period of 29.9 months. Late mortality was 8.4%; 3.1% following AVR, 10.8% following MVR, and 12.5% following DVR. There were no cases of mechanical prosthetic valve failure, significant hemolysis, infective prosthetic valve endocarditis, or bleeding complications. After 44 months of follow-up, the actuarial freedom from complications was calculated as: thromboembolism, 97.8 +/- 1.6%; valve thrombosis, 97.8 +/- 1.1%; paravalvular leak, 96.7 +/- 1.9%; and reoperation, 98.9 +/- 1.1%. The overall survival rate was 84.3 +/- 6.3% and all survivors showed a significant improvement in NYHA functional class, from 81% in classes III and IV preoperatively to 99% in classes I and II postoperatively. The CM valve exhibited no significant differences in hemolytic parameters or hemodynamic performance after isolated AVR or MVR compared with the similar type of St. Jude Medical bileaflet valve. The evidence provided by the present study therefore suggests that the CM valve prosthesis can achieve excellent mid-term clinical results and hemodynamic performance with a low incidence of thromboembolism and valve thrombosis.
本文回顾了1990年4月至1992年12月期间接受CarboMedics（CM）瓣膜置换术的95例患者。整个组的手术死亡率为4.2%：主动脉瓣置换术（AVR）后为0%，双瓣膜置换术（DVR）后为2.7%。所有患者均接受华法林和布可隆抗凝治疗，平均随访29.9个月。晚期死亡率为8.4%；AVR后为3.1%，二尖瓣置换术（MVR）后为10.8%，DVR后为12.5%。没有机械人工瓣膜故障、严重溶血、人工瓣膜心内膜炎感染或出血并发症的病例。随访44个月后，并发症的精算无事件生存率计算如下：血栓栓塞，97.8±1.6%；瓣膜血栓形成，97.8±1.1%；瓣周漏，96.7±1.9%；再次手术，98.9±1.1%。总生存率为84.3±6.3%，所有幸存者的纽约心脏协会（NYHA）功能分级均有显著改善，术前III级和IV级患者占81%，术后I级和II级患者占99%。与类似类型的圣犹达医疗双叶瓣膜相比，CM瓣膜在孤立性AVR或MVR后的溶血参数或血流动力学性能方面没有显著差异。因此，本研究提供的证据表明，CM瓣膜假体可以实现优异的中期临床结果和血流动力学性能，血栓栓塞和瓣膜血栓形成的发生率较低。
