人工心脏瓣膜置换手术后的远期随访

Long-term clinical results after heart valve replacement

目的 随访 5 5 0 6例次人工心脏瓣膜置换术后病人的远期临床结果 ,全面评价远期疗效。方法 1976年 5月至 1997年 5月 ,在阜外心血管病医院外科实施人工瓣膜置换手术 5 5 0 6例次 ,共 5 2 79例病人 ,其中男 2 76 8例 ,女 2 5 11例 ;平均年龄 (39 86± 10 73)岁。共置换人工瓣膜 6 816枚。总随访率为86 8% ,平均随访 6 5 9年 (0 80～ 2 2 5 8年 ) ,随访总人年次为 2 86 0 8 94病人 年。结果 手术总死亡率为5 98%。人工生物瓣膜结构性衰坏发生率 1 5 7%病人 年。全组血栓栓塞发生率 0 2 2 %病人 年 (机械瓣组为 0 2 8%病人 年 ,生物瓣组为 0 0 7%病人 年 ,P =0 0 0 0 0 )。出血事件发生率 1 0 0 %病人 年 (机械瓣组为 1 34%病人 年 ,生物瓣组为 0 15 %病人 年 ,P =0 0 0 0 0 )。再手术为 0 4 5 %病人 年 (机械瓣组 0 0 2 %病人 年 ,生物瓣组为 1 6 1%病人 年 ,P =0 0 0 0 0 )。再手术原因以生物瓣衰坏为主 ,占再手术 96 35 %。远期死亡率 0 79%病人 年 ,5年生存率 (96 34± 0 31) % ,10年生存率 (92 4 8± 0 5 8) % ,15年生存率 (87 97± 1 13) % ,2 0年生存率 (82 5 1± 2 94 ) %。远期瓣膜相关死亡率 0 6 0 %病人 年 ,5年免除瓣膜相关死亡(97 2 1± 0 2 7) % 。

Objective: This report reviewed the experience of long term clinical results of 5?506 prosthetic heart valve replacement. Methods: From May, 1976 to May, 1997, artificial valve prostheses replacements were performed in 5?279 patients with 5?506 valves. The mean age was (39.86±10.73) year old. Follow up period ranged from 0.8 year to 22.58 years, and the mean follow up period was 6.59 years. Total follow up was 28?608.94 patient years. The follow up was completed in 86.8% of patients. Results: Total operative mortality was 5.98%. The rate of strutural valve dysfunction (SVD) for bioprosthetic valve was 1.57% pt yr. The linearized rate of thromboembolism was 0.22% pt yr, and for mechanical valve group was 0.28% pt yr and 0.07% pt yr for bioprosthetic valve group (P=0.0000). The rate of bleeding event was 1.00% pt yr, and for mechanical valve group was 1.34% pt yr and 0.15% pt yr for bioprosthetic valve group (P=0.0000). The rate of re operation was 0.45% pt yr, for mechanical valve group 0.02% pt yr, for bioprosthetic valve group 1.61% pt yr (P=0.0000). The mortality was 0.79% pt yr, the actuarial probability of survival was (96.34±0.31)% at 5 years, (92.48±0.58)% at 10 years, (87.98±1.13)% at 15 years and (82.51±2.94)% at 20 years. The rate of valve related mortality was 0.60% pt yr, actuarial freedom from valve relate death was (97.21±0.27)% at 5 years, (94.50±0.49)% at 10 years, (90.80±1.02)% at 15 years and (88.01±1.80)% at 20 years. The rate of all valve related morbidity was 1.63% pt yr. Conclusion: The results of this study indicated that Chinese person with artificial heart valve replacement had good survival rate.