Bessell J R, Gower G, Craddock D R, Stubberfield J, Maddern G J
Cardio-Thoracic Surgical Unit, Royal Adelaide Hospital, Australia.
Aust N Z J Surg. 1996 Dec;66(12):799-805. doi: 10.1111/j.1445-2197.1996.tb00753.x.
Thirty years have elapsed since the commencement of open-heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic aortic valve replacement during this period.
Questionnaires and personal contact have been used to generate a combined database of pre-operative and post-operative information and long-term follow-up on 1322 patients who underwent isolated prosthetic aortic valve replacement at the Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1992.
Complete survival follow-up data were obtained for 94% (1241) of the patients. The Bjork-Shiley valve was used in 66% (875) of the patients, a Starr-Edwards prosthesis in 31% (412), a St Jude prosthesis in 2% (26), and only 0.7% (9) bioprosthetic valves were inserted. The hospital mortality rate for the 30-year period was 2.9%. Progressively older and less fit patients have undergone surgery in recent years. The long-term survival of patients with aortic stenosis and aortic incompetence was not significantly different. Long-term survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications, and for patients in pre-operative atrial fibrillation. Pre-operative dyspnoea was significantly improved following aortic valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series.
Aortic valve replacement can be performed with low hospital mortality and complication rates, and significant symptomatic improvement can be expected. Aortic valve recipients have a favourable prognostic outcome compared with an age- and sex-matched population, and risk factors that determine long-term survival can be identified pre-operatively.
南澳大利亚开展心脏直视手术至今已有30年。本研究进行回顾性分析，以评估在此期间接受人工主动脉瓣置换术的所有患者的死亡率和并发症发生率，并确定与预后不良相关的因素。
通过问卷调查和个人联系，建立了一个综合数据库，收集了1963年至1992年间在皇家阿德莱德医院心胸外科接受单纯人工主动脉瓣置换术的1322例患者的术前和术后信息以及长期随访资料。
94%（1241例）的患者获得了完整的生存随访数据。66%（875例）的患者使用了比约克-希利瓣膜，31%（412例）使用了斯塔尔-爱德华兹人工瓣膜，2%（26例）使用了圣犹达人工瓣膜，仅0.7%（9例）植入了生物瓣膜。30年间的医院死亡率为2.9%。近年来，接受手术的患者年龄越来越大，身体状况也越来越差。主动脉瓣狭窄和主动脉瓣关闭不全患者的长期生存率无显著差异。纽约心脏协会（NYHA）功能分级较高的患者以及术前房颤患者的长期生存率明显较短。主动脉瓣置换术后，术前呼吸困难症状明显改善。与其他已发表的系列研究相比，术后出血和栓塞并发症的发生率较低。
主动脉瓣置换术可在低医院死亡率和并发症发生率的情况下进行，并且有望显著改善症状。与年龄和性别匹配的人群相比，主动脉瓣置换患者的预后良好，并且术前可确定决定长期生存的危险因素。
