Aoyagi S, Oryoji A, Nishi Y, Tanaka K, Kosuga K, Oishi K
Second Department of Surgery, Kurume University School of Medicine, Japan.
J Thorac Cardiovasc Surg. 1994 Dec;108(6):1021-9.
Between 1980 and 1992, 908 patients underwent single aortic (n = 178), single mitral (n = 577), or double aortic and mitral (n = 153) valve replacement with the St. Jude Medical valve at our hospital. There were 392 male patients and 516 female patients whose ages ranged from 1.2 to 74 years (mean, 52 years). The early mortality rate was 5.0% (45 patients). A 94% complete follow-up was accomplished for 863 patients who were discharged from the hospital (4682.3 patient-years). Sixty-nine of these patients died, for a late mortality rate of 8.0%. Fifty-two patients, including four patients (0.3%/100 patient-years) had anticoagulant-related hemorrhage, 4(0.1%/100 patient-years) had prosthetic valve endocarditis, 11 (0.2%/100 patient-years) had nonstructural valve dysfunction, and 16 (0.3%/100 patient-years) underwent reoperation. There were no structural valve failures in this series. The total number of valve-related deaths was 22. Of those patients who survived, 98% were in New York Heart Association functional class I or II at the date of the last follow-up. The probabilities of freedom from thromboembolism and anticoagulant-related hemorrhage at 10 years were 94% +/- 2% and 97% +/- 2% in aortic valve replacement, 89% +/- 2% and 98% +/- 4% in mitral valve replacement, and 89% +/- 6% and 92% +/- 6% in double valve replacement, respectively. Significant hemolysis related to the St. Jude Medical valve occurred in 8 of the 577 patients who received mitral valve replacement in our early experience, and modifying the valve orientation appeared to play an important role in reducing hemolysis. The event-free rate, including all complications and late deaths, at 10 years was 75% +/- 7%, 74% +/- 3%, and 81% +/- 6% in aortic valve replacement, mitral valve replacement, and double valve replacement, respectively. On the basis of these results, the St. Jude Medical valve seems to be an excellent mechanical valve in terms of durability and low thrombogenicity and remains our prosthetic valve of choice when valve replacement with a mechanical valve is indicated.
1980年至1992年间，我院908例患者接受了圣犹达医疗公司生产的瓣膜进行单主动脉瓣（n = 178）、单二尖瓣（n = 577）或双主动脉瓣和二尖瓣（n = 153）置换术。其中男性患者392例，女性患者516例，年龄范围为1.2岁至74岁（平均52岁）。早期死亡率为5.0%（45例患者）。对863例出院患者（4682.3患者年）进行了94%的完整随访。其中69例患者死亡，晚期死亡率为8.0%。52例患者（包括4例患者，0.3%/100患者年）发生抗凝相关出血，4例（0.1%/100患者年）发生人工瓣膜心内膜炎，11例（0.2%/100患者年）发生非结构性瓣膜功能障碍，16例（0.3%/100患者年）接受再次手术。本系列中未发生结构性瓣膜故障。瓣膜相关死亡总数为22例。在存活的患者中，98%在最后一次随访时处于纽约心脏协会功能分级I或II级。主动脉瓣置换术后10年无血栓栓塞和抗凝相关出血的概率分别为94%±2%和97%±2%，二尖瓣置换术后分别为89%±2%和98%±4%，双瓣膜置换术后分别为89%±6%和92%±6%。在我们早期的经验中，577例接受二尖瓣置换的患者中有8例发生了与圣犹达医疗瓣膜相关的明显溶血，改变瓣膜方向似乎在减少溶血方面起重要作用。主动脉瓣置换术、二尖瓣置换术和双瓣膜置换术10年的无事件发生率（包括所有并发症和晚期死亡）分别为75%±7%、74%±3%和81%±6%。基于这些结果，就耐久性和低血栓形成性而言，圣犹达医疗瓣膜似乎是一种优秀的机械瓣膜，当需要进行机械瓣膜置换时，它仍然是我们的首选人工瓣膜。
