심장 판막치환 환자의 술후 장기성속

Abstract

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. Fifty.one 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 deaths 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