Aupart M R, Sirinelli A L, Diemont F F, Meurisse Y A, Dreyfus X B, Marchand M A
Department of Cardiac Surgery, Trousseau University Hospital, Tours, France.
Ann Thorac Surg. 1996 Feb;61(2):615-20. doi: 10.1016/0003-4975(95)00953-1.
The first generation of pericardial valves has been withdrawn from the market because of excessively high rates of premature failure. With its original design, the Carpentier-Edwards pericardial valve has promised improved results.
In our institution, 589 patients underwent an isolated aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis between July 1984 and December 1993. The patients' mean age was 67.5 +/- 11.2 years, and 49% of the patients were in New York Heart Association clinical class III or IV. The operative mortality rate was 2.3% (14 of 595). All patients but 4 were followed up for an average of 4.1 years after their operation, and total follow-up was 2,408 patient-years.
At the time of the study, more than 85% of the patients were in New York Heart Association class I or II. There were 79 late deaths. After 10 years, the actuarial survival rate was 71% +/- 7%. Nineteen patients died of valve-related causes (3 endocarditis, 7 thromboembolic complications, 1 structural failure, and 8 sudden deaths). The actuarial rate of freedom from valve-related death was 94% +/- 3% at 10 years. Valve-related complications included 23 thromboembolic episodes (0.9% per patient-year), 14 endocarditis (0.5% per patient-year), 9 reoperations (0.4% per patient-year), and 4 structural valve failures with calcification and stenosis (0.2% per patient-year). After 10 years, freedom from valve-related complications was 84% +/- 6%, from reoperation 97% +/- 2%, and from valve failure 96% +/- 4%.
Because of its low rate of valve-related events at 10 years and low rate of structural deterioration with no leaflet tears, this prosthesis is an outstanding choice for patients who need tissue valves and for patients aged 60 years or older.
第一代心包瓣膜因过早失败率过高已退出市场。凭借其原始设计，卡朋蒂埃 - 爱德华兹心包瓣膜有望取得更好的效果。
在我们机构，1984年7月至1993年12月期间，589例患者接受了使用卡朋蒂埃 - 爱德华兹心包生物瓣膜的单纯主动脉瓣置换术。患者的平均年龄为67.5±11.2岁，49%的患者属于纽约心脏协会临床分级III或IV级。手术死亡率为2.3%（595例中的14例）。除4例患者外，所有患者术后平均随访4.1年，总随访时间为2408患者年。
在研究时，超过85%的患者属于纽约心脏协会I级或II级。有79例晚期死亡。10年后，精算生存率为71%±7%。19例患者死于瓣膜相关原因（3例心内膜炎、7例血栓栓塞并发症、1例结构故障和8例猝死）。10年时无瓣膜相关死亡的精算率为94%±3%。瓣膜相关并发症包括23次血栓栓塞事件（每年0.9%/患者）、14例心内膜炎（每年0.5%/患者）、9次再次手术（每年0.4%/患者）以及4例伴有钙化和狭窄的瓣膜结构故障（每年0.2%/患者）。10年后，无瓣膜相关并发症的比例为84%±6%，无再次手术的比例为97%±2%，无瓣膜故障的比例为96%±4%。
由于该瓣膜在10年时瓣膜相关事件发生率低，且结构退化率低且无瓣叶撕裂，对于需要组织瓣膜的患者以及60岁及以上的患者而言，这种人工瓣膜是一个出色的选择。
