Westaby S, Van Nooten G, Sharif H, Pillai R, Caes F
Oxford Heart Centre, John Radeliffe Hospital, UK.
Eur J Cardiothorac Surg. 1996;10(8):660-5. doi: 10.1016/s1010-7940(96)80382-4.
We sought to evaluate the ATS open pivot bileaflet valve with respect to haemodynamics and thromboembolism.
We prospectively studied 200 consecutive patients aged 13-80 years. One hundred and nineteen aortic, 103 mitral and 11 tricuspid valves were replaced in 172 single, 23 double and 5 triple valve procedures. Thirty-eight were re-operations and 51 underwent coronary bypass. Transvalvular gradients were determined by transoesophageal and transthoracic echocardiography. Patients were followed for 12 months to 3 years.
There were four hospital (2%) and three late deaths, each non-valve related. Two patients were reoperated for partial valve dehiscence. One aortic reoperation patient suffered a potential transient thromboembolic event. One tricuspid prosthesis thrombosed after anticoagulation was discontinued but thrombolysis resolved this problem. There were no other thromboembolic events. Valve gradients were equivalent or better than those for other bileaflet valves.
The ATS valve has excellent haemodynamic characteristics and a very low thromboembolic rate, probably related to the convex self-washing hinge mechanism. Consequently, we have reduced anticoagulant levels to INR (international normalised ratio) 1.5 to 2.0 for aortic valve patients in sinus rhythm. Early experience suggests that the ATS valve functions well in the tricuspid position.
我们旨在评估ATS开放枢轴双叶瓣在血流动力学和血栓栓塞方面的表现。
我们前瞻性地研究了200例年龄在13至80岁之间的连续患者。在172例单瓣膜、23例双瓣膜和5例三瓣膜置换手术中，置换了119个主动脉瓣、103个二尖瓣和11个三尖瓣。38例为再次手术，51例接受了冠状动脉搭桥术。通过经食管和经胸超声心动图测定跨瓣压差。对患者进行了12个月至3年的随访。
有4例（2%）患者在住院期间死亡，3例为晚期死亡，均与瓣膜无关。2例患者因瓣膜部分裂开而再次手术。1例主动脉瓣再次手术患者发生了一次可能的短暂血栓栓塞事件。1例三尖瓣人工瓣膜在停用抗凝治疗后发生血栓形成，但溶栓治疗解决了该问题。未发生其他血栓栓塞事件。瓣膜压差与其他双叶瓣相当或更好。
ATS瓣膜具有优异的血流动力学特性和极低的血栓栓塞率，这可能与凸面自冲洗铰链机制有关。因此，对于窦性心律的主动脉瓣置换患者，我们已将抗凝水平降至国际标准化比值（INR）1.5至2.0。早期经验表明，ATS瓣膜在三尖瓣位置功能良好。
