Arom K V, Goldenberg I F, Emery R W
Minneapolis Heart Institute, MN.
J Heart Valve Dis. 1994 Sep;3(5):531-6.
Records of 144 patients who received size 19 or 21 mm (Group A) aortic Standard St. Jude Medical (SSJM) prostheses were retrospectively reviewed and compared to 219 patients who received size 25 mm SSJM valves (Group B). Group A patients were older (70 +/- 9 years vs. 62 +/- 13 years) and had smaller body surface area (BSA) (1.65 m2 vs. 1.9 m2 p < 0.05). Operative mortality (5% vs. 2%) and postoperative unadjusted Doppler mean gradient (31 mmHg vs. 22 mmHg) were higher in Group A (p < 0.05). Total follow up was 1255 patient-years (450.6 Group A/804.4 Group B). There were no perivalvular leaks, valve thrombosis, or endocarditis in either group. Freedom from thromboembolism and anticoagulant-related hemorrhage was 89% and 95% in Group A and 93% and 98% in Group B, respectively. The major causes of late death were older age and progressive cardiac disease. The five-year actuarial analysis revealed a survival rate of 74% in Group A and 83% in Group B (p < 0.05). Of those who were alive, more than 70% were in functional class I and II. These patients not only enjoy a complication-free living but are able to perform daily routine activity despite being older. 19 mm and 21 mm SSJM aortic valve prostheses had higher transprosthetic gradient, but provided satisfactory performance in adult patients with a BSA of less than 1.7 m2. This valve can be used in the small aortic annulus with a valve size index of at least 12 mm/m2 as an alternative to an annular enlargement procedure.
对144例接受19或21毫米（A组）标准圣犹达医疗公司（SSJM）主动脉瓣膜假体的患者记录进行回顾性分析，并与219例接受25毫米SSJM瓣膜的患者（B组）进行比较。A组患者年龄更大（70±9岁 vs. 62±13岁），体表面积（BSA）更小（1.65平方米 vs. 1.9平方米，p<0.05）。A组的手术死亡率（5% vs. 2%）和术后未调整的多普勒平均压差（31 mmHg vs. 22 mmHg）更高（p<0.05）。总随访时间为1255患者年（A组450.6/ B组804.4）。两组均未出现瓣周漏、瓣膜血栓形成或心内膜炎。A组和B组的血栓栓塞和抗凝相关出血的无事件生存率分别为89%和95%以及93%和98%。晚期死亡的主要原因是年龄较大和进行性心脏病。五年精算分析显示，A组生存率为74%，B组为83%（p<0.05）。在存活患者中，超过70%为心功能I级和II级。这些患者不仅生活中无并发症，而且尽管年龄较大仍能进行日常活动。19毫米和21毫米的SSJM主动脉瓣膜假体跨瓣压差较高，但在体表面积小于1.7平方米的成年患者中提供了令人满意的性能。该瓣膜可用于瓣环尺寸指数至少为12 mm/m2的小主动脉瓣环，作为环扩大手术的替代方案。
