Gometza B, Duran C M
Department of Cardiovascular Disease, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Ann Thorac Surg. 1995 Nov;60(5):1312-6. doi: 10.1016/0003-4975(95)00757-C.
Because of the difficulty of permanent anticoagulation in our young population, Smeloff-Cutter ball valves have been used since 1986 at our institution for aortic valve replacement in selected patients without permanent anticoagulation therapy.
The availability of a satisfactory follow-up system since July 1988 suggested a study of all 47 patients operated on since then and followed for a mean of 43.2 months (range, 16 to 78 months). Mean age was 26.3 years, 98% were in sinus rhythm, and 16 patients (34%) had concomitant mitral repair.
There were no hospital deaths. Three patients were lost to follow-up at a mean of 27 months. Four late deaths occurred (8.5%), two of them sudden, with actuarial survival at 6 years of 91% +/- 4.3%. There were a total of five embolic events (2.9%/patient-year). For isolated aortic valve replacement only, with antiaggregant therapy (n = 29), the incidence was 0.9%/patient-year. For all patients receiving antiaggregant agents (n = 43), it was 3.02%/patient-year. There were no known cases of valve thrombosis. Reoperation was required in 5 patients.
Aortic valve replacement with the Smeloff-Cutter ball valve might be a valid alternative for young patients unable to maintain regular anticoagulation.
由于在我们的年轻人群中进行永久性抗凝存在困难，自1986年以来，我们机构在选定的无需永久性抗凝治疗的患者中使用斯梅洛夫 - 卡特球瓣进行主动脉瓣置换。
自1988年7月起有一个令人满意的随访系统，这使得对自那时起接受手术并平均随访43.2个月（范围16至78个月）的所有47例患者进行研究成为可能。平均年龄为26.3岁，98%为窦性心律，16例患者（34%）同时进行了二尖瓣修复。
无院内死亡病例。3例患者在平均27个月时失访。发生了4例晚期死亡（8.5%），其中2例为猝死，6年实际生存率为91%±4.3%。共有5次栓塞事件（2.9%/患者年）。仅对于接受抗聚集治疗的单纯主动脉瓣置换患者（n = 29），发生率为0.9%/患者年。对于所有接受抗聚集药物治疗的患者（n = 43），发生率为3.02%/患者年。无已知瓣膜血栓形成病例。5例患者需要再次手术。
对于无法维持常规抗凝的年轻患者，使用斯梅洛夫 - 卡特球瓣进行主动脉瓣置换可能是一种有效的替代方法。
