Kuwaki K, Komatsu K, Morishita K, Tsukamoto M, Abe T
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Japan.
Surg Today. 1998;28(6):599-603. doi: 10.1007/s005950050191.
From January 1976 to September 1994, 26 patients underwent a tricuspid valve replacement (TVR) with porcine bioprostheses (Hancock II in 19 patients, Carpentier-Edwards in 3, Hancock standard in 2, Medtronic-Intact in 1, and Liotta in 1). The mean age of these patients was 38.4 years (range, 9 to 70 years). The mean follow-up period was 6.7 years (range, 1.8 to 16.5 years). There was a complete follow-up in 100%. There were two hospital deaths and three late deaths. The actuarial survival rate at 16 years was 78.7%+/-8.6%. Five patients developed structural deterioration. Four of these 5 patients underwent re-TVR. The actuarial freedom rate from structural deterioration at 10 years was 47.1%+/-19.1%. There were no instances of thromboembolism and prosthetic valve endocarditis. Our experience indicated the major problem of the porcine bioprostheses in the tricuspid position thus to be valve durability: however, the long-term actuarial survival rate was satisfactory, including no operative morality with re-TVR due to tricuspid prosthetic structural deterioration. We therefore conclude that the choice of a porcine bioprosthesis in the tricuspid position should be considered not only for patients with isolated tricuspid valve disease, but also for the patients who have not previously received mechanical valves in the mitral or the aortic valve position.
1976年1月至1994年9月，26例患者接受了猪生物瓣膜三尖瓣置换术（TVR）（19例使用Hancock II型，3例使用Carpentier-Edwards型，2例使用Hancock标准型，1例使用Medtronic-Intact型，1例使用Liotta型）。这些患者的平均年龄为38.4岁（范围9至70岁）。平均随访期为6.7年（范围1.8至16.5年）。随访率达100%。有2例住院死亡和3例晚期死亡。16年时的精算生存率为78.7%±8.6%。5例出现结构恶化。这5例患者中有4例接受了再次TVR。10年时结构恶化的精算自由度为47.1%±19.1%。未发生血栓栓塞和人工瓣膜心内膜炎病例。我们的经验表明，猪生物瓣膜在三尖瓣位置的主要问题是瓣膜耐久性：然而，长期精算生存率令人满意，包括因三尖瓣人工瓣膜结构恶化行再次TVR时无手术死亡。因此，我们得出结论，三尖瓣位置选择猪生物瓣膜不仅应考虑孤立性三尖瓣疾病患者，也应考虑二尖瓣或主动脉瓣位置此前未接受机械瓣膜的患者。
