[使用 Björk-Shiley 倾斜盘式瓣膜进行瓣膜置换的手术结果]

[Surgical results of valve replacement with the Björk-Shiley tilting disc valves].

作者信息

Saigenji H, Toyohira H, Shimokawa S, Moriyama Y, Watanabe S, Koga M, Toda R, Yamashita T, Yamaoka A, Taira A

机构信息

Second Department of Surgery, Kagoshima University Faculty of Medicine, Japan.

出版信息

Nihon Kyobu Geka Gakkai Zasshi. 1996 May;44(5):641-5.

PMID:8964993

Abstract

We evaluated the Björk-Shiley tilting-disc (BS) valve replacement up to the longest duration for about 12 years. The study was started in November 1982 and ended in September 1991. There were total number of 206 with 117 males and 89 females aged between 18 and 71 with a mean of 51.6. Eighty three patients had isolated aortic valve replacement (AVR), 92 had isolated mitral valve replacement (MVR), and 31 had AVR plus MVR. One hundred and fourteen spherical-disc valves were replaced in the aortic, 112 spherical and 11 monostrut in the mitral position. The mean duration of follow up was 6.5 years for a total of 1330.6 patient years (PY). Forty-one patients (3.8%/PY) died later, and 14 out of 41 died of valve-related complications. Actuarial survival rates for all, AVR, MVR and DVR at 10 years after operation were 71.2%, 73.5%, 73.9% and 55.4%, respectively. The linearized rates of thromboembolism (TE), thrombosed valve (TV), anticoagulant-related hemorrhage (ACH), prosthetic valve endocarditis (PVE), hemolysis (H), and reoperation (RO) were 1.2%/PY, 0.2%/PY, 0.7%/PY, 0.2%/PY, 0.1%/PY, and 0.2%/PY, respectively. The rates of freedom from TE, TV, ACH, PVE, H, and RO and 10 years after operation were 83.5%, 98.5%, 94.0%, 98.4%, 99.0% and 95.6%, respectively. The major causes of postoperative mortality and morbidity were TE, TV, and ACH. One hundred and fifty-six out of 161 patients showed an improvement in NYHA functional class post operatively. The surgical results of valve replacement with the BS valve was excellent and acceptable one. Intensive management with a special reference of anticoagulant therapy is necessary for a long-term management of the patients with mechanical valve replacement.

摘要

我们对Björk-Shiley倾斜碟瓣（BS瓣）置换术进行了长达约12年的评估。该研究始于1982年11月，结束于1991年9月。共有206例患者，其中男性117例，女性89例，年龄在18至71岁之间，平均年龄为51.6岁。83例患者接受了单纯主动脉瓣置换术（AVR），92例接受了单纯二尖瓣置换术（MVR），31例接受了主动脉瓣置换加二尖瓣置换术。主动脉瓣位置换了114个球形碟瓣，二尖瓣位置换了112个球形瓣和11个单支柱瓣。平均随访时间为6.5年，总计1330.6患者年（PY）。41例患者（3.8%/PY）随后死亡，41例中有14例死于瓣膜相关并发症。术后10年时，所有患者、AVR患者、MVR患者和双瓣膜置换患者的精算生存率分别为71.2%、73.5%、73.9%和55.4%。血栓栓塞（TE）、瓣膜血栓形成（TV）、抗凝相关出血（ACH）、人工瓣膜心内膜炎（PVE）、溶血（H）和再次手术（RO）的线性化发生率分别为1.2%/PY、0.2%/PY、0.7%/PY、0.2%/PY、0.1%/PY和0.2%/PY。术后10年时，无TE、TV、ACH、PVE、H和RO的发生率分别为83.5%、98.5%、94.0%、98.4%、99.0%和95.6%。术后死亡和发病的主要原因是TE、TV和ACH。161例患者中有156例术后纽约心脏协会（NYHA）心功能分级有所改善。BS瓣置换术的手术效果极佳且可接受。对于机械瓣膜置换患者的长期管理，有必要特别参照抗凝治疗进行强化管理。