259例应用国产C—L短柱侧倾碟瓣行二尖瓣置换术后15年随访

目的评价应用国产C—L短柱侧倾碟瓣行二尖瓣置换术的近期与远期疗效，分析影响手术疗效的因素，以提高手术疗效。方法回顾性分析自1991年10月至2006年11月，259例用国产C—L短柱侧倾碟瓣行二尖瓣置换术患者的临床资料和长期随访结果。结果本组早期死亡12例，死亡率为4．63％（12／259）。术后早期未出现与心瓣膜相关的并发症。1996年以后病死率降至2．59％。随访235例患者，12例失访，随访率95．1％（235／247），随访时间9．77±3．09年。晚期死亡患者26例，随访期间无由于心瓣膜结构损坏导致的患者死亡。5年，10年和15年的生存率分别为86．80％±2．30％，78．20％±3．33％和55．23％±4、34％；无血栓栓塞率5年，10年和15年分别为95．95％±0．74％，92．52％±4．11％和80．52％±4．11％；无出血率5年，10年和15年分别为94．64％±1．75％，89．55％±3．28％和79，39％±4．43％。心功能分级（NYHA）Ⅰ级141例（67．46％），Ⅱ级56例（26．79％），Ⅲ级10例（4．78％），Ⅳ级2例（0．95％）。结论通过15年的长期随访显示，行二尖瓣置换术选择国产C—L短柱侧倾碟瓣是安全可靠的。

Fifteen Years Follow-up of 259 Patients of Mitral Valve Replacement with Chinese-made C-L Pugesturt Tilting Disc Mechanical Valve Prosthesis

Objective To evaluate the early and late results of mitral valve replacement with home made C-L pugesturt tilting disc and analyse the factors which impact on the therapeutic effect, so as to elevate the operative effect. Methods A retrospective study was made on the result of clinical data and long-term follow-up of 259 patients who had undergone the Chinese-made C-L pugesturt tilting disc mechanical valve replacement from October 1991 to November 2006. Results The data showed that there were 12 patients died in the duration of hospital stay. The hospital mortality was 4.63% （12/259）. There were no mechanical valve-related complication in the earlier postoperative period. The mortality fell to 2.59% since 1996. Among the 235 patients, 12 patients were lost during the follow-up,the rate of follow-up was 95.1% （235/247）. The time for follow-up was 9.77-3.09 years. There were 26 late deaths. During the follow-up,death associated with the deterioration of valve structure were not observed. The 5 years, 10 years and 15 years survival rates were 86. 80%± 2. 30%, 78. 20%± 3. 33% and 55. 23%± 4. 34% respectively; the thromboembolic event free rates for 5 years, 10 years and 15 years were 95. 95%± 0. 74%, 92.52%±4.11% and 80. 52%±4. 11% respectively; the anticoagulant related bleeding free rates for 5 years, 10 years and 15 years were 94. 64%±1. 75%, 89. 55%±3. 28% and 79. 39%±4. 43% respectively. There were 141 patients （67.46%） in New York Heart Association（NYHA） class Ⅰ , 56 patients（26. 79%） in class Ⅱ , 10 patients （4.78%） in class Ⅲ and 2 patients（0.95%） in class Ⅳ. Conclusion The results of follow-up for 15 years suggest that the Chinese-made C-L pugesturt tilting disc medical mechanical valve is a reliable and safe choice for mitral valve replacement.