Bessell J R, Gower G, Craddock D R, Stubberfield J, Maddern G J
Cardio-Thoracic Surgical Unit, Royal Adelaide Hospital, North Terrace, Australia.
Aust N Z J Surg. 1996 Dec;66(12):806-12. doi: 10.1111/j.1445-2197.1996.tb00754.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 mitral 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 938 patients who underwent isolated prosthetic mitral valve replacement at the Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1993.
Complete survival follow-up data were obtained for 92% (865) of the patients. The Starr-Edwards valve was used in 95% (891) of the patients, a Bjork-Shiley prosthesis in 2.5% (23) of the patients, and only 24 (2.5%) other valves were inserted. The hospital mortality rate for the 30-year period was 4.7%. The mean age of the patients who underwent surgery was greater in each of the three successive decades. A long-term survival advantage was observed for patients with mitral stenosis, however, 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 mitral valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series.
Mitral valve recipients do not regain a normalized life expectancy, but risk factors that determine long-term survival can be identified pre-operatively to aid appropriate patient selection.
南澳大利亚开展心脏直视手术已有30年。本研究进行回顾性分析，以评估在此期间接受人工二尖瓣置换术的所有患者的死亡率和并发症发生率，并确定与不良预后相关的因素。
通过问卷调查和个人联系，收集了1963年至1993年间在皇家阿德莱德医院心胸外科接受单纯人工二尖瓣置换术的938例患者的术前和术后信息以及长期随访的综合数据库。
92%（865例）患者获得了完整的生存随访数据。95%（891例）患者使用了斯塔尔-爱德华兹瓣膜，2.5%（23例）患者使用了比约克-希利假体，仅植入了24个（2.5%）其他瓣膜。30年间的医院死亡率为4.7%。在连续三个十年中，接受手术患者的平均年龄都更大。二尖瓣狭窄患者具有长期生存优势，然而，纽约心脏协会（NYHA）功能分级较高的患者和术前房颤患者的生存期明显较短。二尖瓣置换术后，术前呼吸困难症状明显改善。与其他已发表系列相比，术后出血和栓塞并发症发生率较低。
二尖瓣置换患者无法恢复正常预期寿命，但术前可确定决定长期生存的危险因素，以帮助进行适当的患者选择。
