Yamak B, Sener E, Kiziltepes U, Gol K, Tarcan O, Mavitas B, Tasdemir O, Bayazit K
Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey.
J Heart Valve Dis. 1995 May;4(3):274-8.
Between September 1986 and January 1994, 129 St. Jude Medical prostheses were implanted in 113 patients who were 18-year-old or younger at the Cardiovascular Surgery Clinic of Turkiye Yuksek Ihtisas Hospital. Thirty-seven patients underwent aortic, 60 patients mitral and the remaining 16 patients double valve replacement. Overall hospital mortality was 7.9% (9/113). All patients received 2.5 mg/day warfarin from the first postoperative day, in addition 225 mg/day dipyridamole and 100 mg/day aspirin was given following the removal of mediastinal tubes. This regimen was continued indefinitely thereafter. Follow up period ranged between 2-94 months. Total follow up experience was 276.4 patient-years. There were five late deaths; the cause of death was prosthetic valve thrombosis in two patients, intracerebral hemorrhage in one, cardiomyopathy in one, and sudden death in one. Other late complications included one endocarditis, a further anticoagulant related bleeding and one paravalvular leak. There was no case of cerebral or peripheral embolism reported. Seven-year actuarial survival was 92.4 +/- 6.8% for the entire group, 84.6 +/- 13.8% after mitral and 100% after aortic or double valve replacement. In conclusion, low dose oral anticoagulation after heart valve replacement with St. Jude Medical prosthesis in this age group showed satisfactory clinical results.
1986年9月至1994年1月期间，土耳其伊赫蒂萨斯医院心血管外科诊所为113名18岁及以下患者植入了129个圣犹达医疗公司的假体。37例患者接受了主动脉瓣置换，60例患者接受了二尖瓣置换，其余16例患者接受了双瓣膜置换。总体医院死亡率为7.9%（9/113）。所有患者术后第一天起接受2.5毫克/天的华法林治疗，此外，拔除纵隔引流管后给予225毫克/天的双嘧达莫和100毫克/天的阿司匹林。此后该方案无限期持续。随访期为2至94个月。总随访经验为276.4患者年。有5例晚期死亡；死亡原因分别为2例人工瓣膜血栓形成、1例脑出血、1例心肌病和1例猝死。其他晚期并发症包括1例心内膜炎、1例抗凝相关出血和1例瓣周漏。未报告脑栓塞或外周栓塞病例。整个组的7年精算生存率为92.4±6.8%，二尖瓣置换后为84.6±13.8%，主动脉瓣或双瓣膜置换后为100%。总之，在这个年龄组中，使用圣犹达医疗公司假体进行心脏瓣膜置换后采用低剂量口服抗凝治疗显示出令人满意的临床效果。
