심장 판막치환 환자의 술후 장기성속
Early and Late Clinical Results of Cardiac Valve Replacement

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서울대학교 의과대학
Seoul J Med 1981;22(1):117-130
A total and consecutive 331 patients have undergone
cardiac valve replacement in a l2-year period between
June 1968 and July 1980. They were 170 males and
161 females with the ages ranging from 2 to 63 (mean
30.3±13.6) years, and 18 were children under the
age of fifteen.
Fifty-nine patients had 6 kinds of prosthetic valves
and 272 patients had 4 kinds of xenograft bioprosthetic
valves. Isolated replacements were 225 mitral
valves. 37 aortic valves and 6 tricuspid valves; double
replacements were 38 mitral and aortic valves and 22
mitral and tricuspid valves; triple replacements were
3 mitral. aotric and tricuspid valves. Additional surgical
procedures were necessary in 17.2% of cases. patients died within 30 days after surgery
with an' operative mortality rate of 15.4%: 42.4%
and 9.6% for prosthetic and bioprosthetic groups
respectively. Myocardial failure and ventricular arrhythmias
were the leading causes of early deaths. Of
280 early survivors 94.3% were on coumadin through
life in prosthetic group and for a year in bioprosthetic group.
In a follow-up period of 3,814 patient-months 32
patients developed late complications and 15 died with
a late mortality rate of 4.5%: 15.3% and 2.2%
for prosthetic and bioprosthetic groups respectively.
Thromboembolisms and bleedings associated wi th
anticoagulants were the more frequent complications.
Eleven patients (3.9%) experienced embolic episodes
causing 3 deaths , with the incidences of thromboemboli
at a rate of 3. 46%/patient-year for all patients: 7.73%
/patient year and 2.37%/patient-year for prosthetic
and bioprosthetic groups. Major bleeding complications
associated with oral anticoagulants occurred
at a rate of 2.20%/patient-year resulting another 3
Postoperative functions were Class I or II in 96.8%
of 280 early survivors at the end of follow-ups , while
they were Class III or IV in 77.6% of 331 patients
before valve replacement. Actuarial survival rates for
a tissue valve group were 90.3% for early and 87. 3%
at 54 months after surgery, and for a prosthetic group
57.3% for early and 41.7% at 63 months. Of a total
331 patients 84.4% survived for more than 1 month
and actuarial survival at 63 months was 78.6%.
These early and late clinical results clearly reflect
a marked improvement in cardiac valve replacement
and the data obtained from the use of tissue valves
arc sufficiently comparable with results from other
major reports. Further efforts for the better results
were also discussed
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)The Seoul Journal of MedicineThe Seoul Journal of Medicine Vol. 22 No.1 (1981)
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