Matsuyoshi T, Kimura M, Tachikawa Y, Nakamura M, Iwakuma A, Morishige N, Nakamura K, Sukehiro S, Kawano Y, Anai K
Department of Cardiovascular Surgery, School of Medicine, Fukuoka University, Japan.
Igaku Kenkyu. 1993 Sep;63(3):85-94.
From February 1977 to January 1993, a total of 52 patients have undergone combined mitral and aortic valve replacement (MAVR) at the Fukuoka University Hospital. The ages at operation ranged from 35 to 72 years (mean, 55.3 years) for 16 males and 36 females. Twenty-five patients received two bioprosthetic valves (group BB); 6 received a combination of bioprosthetic valve and mechanical valve (group BM); and 21 received two mechanical valves (group MM). The previous intra-cardiac operations were performed on 24 patients (46.2%). The purpose of this study was to learn about the long-term clinical results of MAVR and to analyze the difference among three groups. Seven patients died within 30 days of operation or during initial hospitalization (early mortality: 13.5%). Two patients died at late period, 5.8 years and 6.9 years after operation, respectively (linearized occurrence rate: 0.9%/pt-yr). Patient survival rate including operative death was 82.9% +/- 5.7% at 5 years and 79.0% +/- 6.7% at 8 years in the total number of patients. Thromboembolism occurred in 2 patients in group MM (0.9%/pt-yr). Anticoagulant-related hemorrhage occurred only in 1 patient (0.4%/pt-yr in overall), in whom two bioprosthetic valves were implanted (group BB), in spite of being in good control with anticoagulants. No infective endocarditis was encountered in any patients during any of the periods. Reoperations were performed in 7 patients (3%/pt-yr in overall), 5 in group BB and 2 in group MM. Percentage freedom from reoperation was 86.4% +/- 5.9% at 5 years and 78.2% +/- 7.7% at 8 years in all. There was no difference among the three groups. Percentage freedom from overall morbidity and mortality was 74.5% +/- 6.9% at 5 years in all. Group MM showed higher morbidity and mortality at 8 years than other groups, but there were no significance (MM: 52.4% +/- 17.6%, BB: 76.5% +/- 9.5%, BM: 83.3% +/- 15.2%). We conclude that there were no significant differences in long-term results of NAVR which consisted of the following combinations of prostheses such as BB, BM, and MM. Redoing MAVR with New York Heart Association functional class IV and emergency cases were considered as in-hospital risk factors.
1977年2月至1993年1月，福冈大学医院共有52例患者接受了二尖瓣和主动脉瓣联合置换术（MAVR）。手术时年龄在35至72岁之间（平均55.3岁），其中男性16例，女性36例。25例患者植入了两个生物瓣膜（BB组）；6例患者植入了生物瓣膜和机械瓣膜的组合（BM组）；21例患者植入了两个机械瓣膜（MM组）。24例患者（46.2%）曾接受过心脏内手术。本研究的目的是了解MAVR的长期临床结果，并分析三组之间的差异。7例患者在术后30天内或初次住院期间死亡（早期死亡率：13.5%）。2例患者在术后晚期死亡，分别为术后5.8年和6.9年（线性发生率：0.9%/患者年）。包括手术死亡在内的患者生存率在5年时为82.9%±5.7%，在8年时为79.0%±6.7%。MM组有2例患者发生血栓栓塞（0.9%/患者年）。抗凝相关出血仅发生在1例患者中（总体为0.4%/患者年），该患者植入了两个生物瓣膜（BB组），尽管抗凝控制良好。在任何时期，任何患者均未发生感染性心内膜炎。7例患者接受了再次手术（总体为3%/患者年），BB组5例，MM组2例。所有患者在5年时再次手术的无发生率为86.4%±5.9%，在8年时为78.2%±7.7%。三组之间无差异。所有患者在5年时总体发病率和死亡率的无发生率为74.5%±6.9%。MM组在8年时的发病率和死亡率高于其他组，但无统计学意义（MM组：52.4%±17.6%，BB组：76.5%±9.5%，BM组：83.3%±15.2%）。我们得出结论，由BB、BM和MM等假体组合构成的NAVR长期结果无显著差异。纽约心脏协会功能分级为IV级且为急诊病例的再次MAVR被视为院内危险因素。
