Knez I, Mächler H, Rehak P, Oberwalder P, Anelli-Monti M, Dacar D, Rigler B
Clinical Department for Cardiac Surgery, Karl Franzens University, Graz, Austria.
J Heart Valve Dis. 1996 Nov;5 Suppl 3:S294-301.
Aortic valve replacement (AVR) in the small aortic root (SAR) has always been a severe challenge with an uncertain surgical outcome. The purpose of this study was to assess the surgical and clinical performance of 19 mm and 21 mm CarboMedics valves (CPHV) based on a review of valve-related morbidity and mortality over a period of six years.
A total of 361 patients undergoing aortic valve replacement (AVR) with the CPHV between January 1989 and August 1995 was subdivided and studied. (i) Group A patients (n = 137) received 19 mm or 21 mm prostheses; subgroup AI (n = 85) underwent isolated AVR and subgroup AII (n = 52) underwent AVR with associated cardiac procedures. (ii) Group B patients (n = 224) were given 23 mm or larger prostheses; subgroup BI (n = 147) underwent isolated AVR and subgroup BII (n = 77) underwent AVR with concomitant cardiac procedures.
Hospital mortality was group A 7.3% versus group B 4.9%. Cumulative survival after six years was 83.7% in AI and 76.9% in AII versus 72.1% in BI and 77.4% in BII. There were no significant statistical differences between the subgroups concerning cardiac mortality. Thromboembolic events occurred with a linearized rate of 1.41%/pty in group A versus 1.03%/pty in group B, the incidence of anticoagulant-related major hemorrhage was 1.41%/pty in group A versus 1.20%/pty in group B and that of periprosthetic leakage 1.69%/pty in group A versus 1.89%/pty in group B.
Our results demonstrate that this bileaflet prosthesis is highly efficient in patients with small aortic roots undergoing AVR with or without associated procedures.
在小主动脉根部（SAR）进行主动脉瓣置换（AVR）一直是一项严峻挑战，手术结果不确定。本研究旨在通过回顾六年期间与瓣膜相关的发病率和死亡率，评估19毫米和21毫米CarboMedics瓣膜（CPHV）的手术及临床性能。
对1989年1月至1995年8月期间共361例行CPHV主动脉瓣置换术的患者进行分组研究。（i）A组患者（n = 137）接受19毫米或21毫米人工瓣膜；A I亚组（n = 85）接受单纯AVR，A II亚组（n = 52）接受AVR并同期进行心脏手术。（ii）B组患者（n = 224）接受23毫米或更大尺寸的人工瓣膜；B I亚组（n = 147）接受单纯AVR，B II亚组（n = 77）接受AVR并同期进行心脏手术。
A组医院死亡率为7.3%，B组为4.9%。六年累计生存率在A I组为83.7%，A II组为76.9%，而B I组为72.1%，B II组为77.4%。各亚组之间心脏死亡率无显著统计学差异。血栓栓塞事件的线性发生率A组为1.41%/患者年，B组为1.03%/患者年；抗凝相关大出血发生率A组为1.41%/患者年，B组为1.20%/患者年；人工瓣膜周漏发生率A组为1.69%/患者年，B组为1.89%/患者年。
我们的结果表明，这种双叶人工瓣膜在小主动脉根部行AVR（无论是否同期进行其他手术）的患者中效率很高。
