Glower D D, White W D, Hatton A C, Smith L R, Young W G, Wolfe W G, Lowe J E
Department of Surgery, Duke University Medical Center, Durham, NC.
J Thorac Cardiovasc Surg. 1994 Feb;107(2):381-92; discussion 392-3.
During the period of 1977 to 1990, 960 Carpentier-Edwards standard prostheses (Baxter Healthcare Corp., Santa Ana, Calif.) were placed in 875 operations. Freedom from reoperation at 10 years was 57% +/- 4%, 76% +/- 3%, and 95% +/- 5% for mitral, aortic, and tricuspid valve replacement, respectively. Age was the only independent determinant of reoperation for both aortic and mitral valves. Likelihood of reoperation decreased with age, with freedom from reoperation after 10 years in patients aged less than 60 years versus 60 or more years being 65% +/- 5% versus 90% +/- 4% after aortic valve replacement and 48% +/- 5% versus 75% +/- 6% after mitral valve replacement. For mitral valve replacement, larger valve size made reoperation more likely, with freedom from reoperation at 10 years being 71% +/- 6% for sizes median less than 31 mm and 57% +/- 5% for sizes 31 mm or larger. For aortic valve replacement, prior median sternotomy reduced freedom from reoperation at 10 years from 80% +/- 3% to 25% +/- 5%. The low prevalence of reoperation affirms the suitability of the Carpentier-Edwards prosthesis for selected elderly patients and for tricuspid valve replacement. Because of their influence on the probability of reoperation, valve size and prior cardiac procedures also merit consideration in the choice of valvular prosthesis.
在1977年至1990年期间，875例手术中植入了960个Carpentier-Edwards标准人工瓣膜（Baxter Healthcare Corp.，加利福尼亚州圣安娜）。二尖瓣、主动脉瓣和三尖瓣置换术后10年再次手术率分别为57%±4%、76%±3%和95%±5%。年龄是主动脉瓣和二尖瓣再次手术的唯一独立决定因素。再次手术的可能性随年龄增长而降低，主动脉瓣置换术后，年龄小于60岁与60岁及以上患者10年后再次手术率分别为65%±5%和90%±4%；二尖瓣置换术后分别为48%±5%和75%±6%。对于二尖瓣置换术，瓣膜尺寸越大，再次手术的可能性越大，瓣膜尺寸中位数小于31mm者10年后再次手术率为71%±6%，31mm及以上者为57%±5%。对于主动脉瓣置换术，既往正中胸骨切开术使10年后再次手术率从80%±3%降至25%±5%。再次手术的低发生率证实了Carpentier-Edwards人工瓣膜适用于特定老年患者和三尖瓣置换。由于瓣膜尺寸和既往心脏手术对再次手术概率有影响，在选择人工瓣膜时也应考虑这些因素。
