Nakano K, Eishi K, Kosakai Y, Isobe F, Sasako Y, Nagata S, Ueda H, Kito Y, Kawashima Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
J Thorac Cardiovasc Surg. 1996 Mar;111(3):605-12. doi: 10.1016/s0022-5223(96)70312-4.
We reviewed the cases of 66 patients who underwent 67 tricuspid valve replacements with Carpentier-Edwards pericardial xenografts between April 1985 and January 1994. Average patient age at time of operation was 52 years (range 8 to 71 years). Concomitant mitral or aortic valve replacements were performed in 46 patients. There were 10 operative deaths and 6 late deaths. Actuarial survival at 9 years was 75.4% +/- 5.7%. Prosthetic valve endocarditis occurred twice in one patient. Reoperations for tricuspid regurgitation and for concomitant procedures (maze operation and repair for leak of the mitral prosthesis) were performed in two patients. In both cases, examination of the explanted prostheses showed that the tricuspid regurgitation was the result of nonstructural dysfunction caused by fibrous pannus formation on the cusps of the ventricular side. Among the survivors, 47 patients (92%) were in functional class I or II. Prosthetic valve function was studied by color Doppler echocardiography. Among 38 patients, tricuspid regurgitation more than grade 3/4 or transprosthetic gradient more than 5 mm Hg was found in 11. One patient had right heart failure and the others had no symptoms. In 10 years of experience with the Carpentier-Edwards pericardial xenograft, mortality and morbidity after tricuspid valve replacement were satisfactory. Echocardiographic examination revealed subclinical prosthetic dysfunction in 35% of patients who were followed up for longer than 5 years, however, and we believe that these patients should receive careful follow-up.
我们回顾了1985年4月至1994年1月期间66例患者接受67次使用Carpentier-Edwards心包异种移植物进行三尖瓣置换术的病例。手术时患者的平均年龄为52岁（范围8至71岁）。46例患者同时进行了二尖瓣或主动脉瓣置换术。有10例手术死亡和6例晚期死亡。9年的精算生存率为75.4%±5.7%。一名患者发生了两次人工瓣膜心内膜炎。两名患者因三尖瓣反流和相关手术（迷宫手术和二尖瓣人工瓣膜漏修补术）进行了再次手术。在这两例中，对取出的人工瓣膜检查显示，三尖瓣反流是由心室侧瓣叶上纤维性 pannus 形成导致的非结构性功能障碍引起的。在幸存者中，47例患者（92%）的心功能分级为Ⅰ或Ⅱ级。通过彩色多普勒超声心动图研究人工瓣膜功能。在38例患者中，发现11例三尖瓣反流超过3/4级或跨人工瓣膜压差超过5 mmHg。1例患者有右心衰竭，其他患者无症状。在使用Carpentier-Edwards心包异种移植物的10年经验中，三尖瓣置换术后的死亡率和发病率令人满意。然而，超声心动图检查显示，在随访超过5年的患者中，35%存在亚临床人工瓣膜功能障碍，我们认为这些患者应接受密切随访。
