感染性主动脉瓣心内膜炎的外科治疗

目的：报告感染性主动脉瓣心内膜炎的外科治疗经验。方法：７６例感染性主动脉瓣心内膜炎患者，男５８例，女１８例，平均年龄３７．８±１１．３（１２～６０）岁。其中动脉血培养阳性４１例，阴性３５例。２７例（急性活动期）因急性心力衰竭或严重败血症等并发症而急症手术，４９例（慢性静止期）在抗生素治疗６周后择期手术。本组７６例患者行主动脉瓣替换术７４例；应用带瓣管道行主动脉根部、主动脉瓣替换和冠状动脉移植术２例。同期处理动脉导管未闭３例、佛氏窦瘤破裂＋心室间隔缺损６例、心室间隔缺损３例、二尖瓣关闭不全１１例和三尖瓣关闭不全５例。结果：７６例患者术后早期死亡５例（６．６％）：急性活动期２例，慢性静止期３例。术后平均随访４．１５年（１０个月～１０年），晚期死亡４例，其中２例死于人工瓣膜性心内膜炎。结论：感染性主动脉瓣心内膜炎手术时机的掌握对治疗效果至关重要，急症手术并不增加手术死亡率。     

49例儿童心脏瓣膜替换术的经验

目的：报告儿童心脏瓣膜替换术的经验。方法：４９例儿童心脏瓣膜替换者，男３４例，女１５例，年龄５～１４（平均１１６）岁。其中行二尖瓣替换术３２例、主动脉瓣替换术１０例、二尖瓣加主动脉瓣双瓣替换术５例、三尖瓣替换术２例，所用心脏瓣膜均为机械瓣。同期处理合并的心脏病变。结果：术后早期并发症包括：低心输出量综合征５例，呼吸衰竭２例，心律失常２例。其中早期死亡３例，死亡率６１２％。随访０５～１３（平均５４７）年，晚期死亡３例（６５２％）。结论：儿童心脏瓣膜替换时，人工心脏瓣膜尽量选用成人型号，术后常规行华法林抗凝，并要重视对风湿性心脏病瓣膜替换患儿风湿活动的治疗     

感染性心内膜炎的外科治疗

目的：探讨感染性心内膜炎（ＩＥ）的诊断及外科治疗。方法：我院从１９８６年１１月至１９９６年５月，外科治疗感染心内膜炎患者１６例，其中男性１２例，女性４例。手术方法：全麻低温体外循环急诊换瓣手术７例（主动脉瓣替换５例，主动脉瓣＋二尖瓣替换１例，主动脉瓣替换＋膜部心室间隔缺损涤沦补片修补１例）；择期换瓣手术９例（主动脉瓣替换７例，二尖瓣替换２例）。切除瓣周感染组织，对散在于心室间隔和腱索上难以切除的微小赘生物电灼，术毕抗生素溶液冲洗心腔。结果：全组１６例。急诊手术７例，其中术后死亡１例（死亡率１４．３％），死亡原因为多器官衰竭；择期手术９例，无手术死亡。结论：反复多次血培养结合超声心动图检查，可使ＩＥ诊断阳性率大大提高。尽早手术是对部分ＩＥ患者治疗的基本原则，无法控制的感染和心力衰竭是尽早手术治疗的最佳适应证。     

主动脉瓣及二尖瓣双瓣膜替换手术（附28例报告）

本文叙述了主动脉瓣及二尖瓣双瓣膜替换术。２８例病人均为风湿性心脏病。其中２例合并先天性心脏畸型。全组病例均置入人工机械瓣膜，其中８例同时行三尖瓣成形术。术后早期死亡１例，晚期死亡３例。本文对广义的心肌保护，主动脉瓣病变的判定，二尖瓣全周连续缝合，保留二尖瓣装置，三尖瓣的处理，主动脉瓣替换的一些方法，自体输血以及晚期死亡原因及预防等问题做了讨论。     

心脏直视手术中经食管超声心动图描记术的临床研究

目的：探讨术中经食管超声心动图描记术（ＩＴＥＥ）的临床应用价值。方法：回顾性研究总结１０６例接受ＩＴＥＥ检查的患者。结果：６６．０％的患者行瓣膜手术，其中包括二尖瓣成形术、二尖瓣替换术、主动脉瓣替换术、三尖瓣成形术及主动脉瓣、二尖瓣双瓣替换术；１２．３％的患者行左心室流出道疏通术；１１．３％的患者行带瓣主动脉替换术；１０．４％的患者行先天性心脏病矫治术，其中２例患者行经皮穿刺心房间隔缺损钮扣装置封堵术。结论：ＩＴＥＥ能即时评价人工瓣膜位于体内的功能状态，检出瓣周漏；准确地判断左心室流出道疏通的效果；ＩＴＥＥ检查在经皮穿刺缺损封堵术中也有较大的应用潜力。     

施行双瓣膜替换术5例临床体会

施行双瓣膜替换术５例临床体会栖霞市人民医院（２６５３００）娄德剑，林雪维，衣涛源，于佳生，孙绍军我院对５例风湿性心脏病二尖瓣及主动脉瓣双瓣膜病变患者，应用侧倾蝶瓣行主动脉瓣及二尖瓣双瓣膜替换术。其中男３例，女２例；年龄３４～４８岁。术前ＮＹＨＡ心功能...     

主动脉瓣二尖瓣双瓣替换并细小主动脉根部扩大六例治疗体会

主动脉瓣二尖瓣双瓣替换并细小主动脉根部扩大六例治疗体会白树堂李正国何伦德何书武⒇１临床资料海南心血管病医院１９９２年～１９９６年施行了二尖瓣替换及细小主动脉根部（ＳＡＡ）扩大主动脉瓣替换术６例。其中男性２例，女性４例，年龄１８～５３岁，体重３２～５５...     

二尖瓣狭窄闭式扩张术后的瓣膜替换术

目的：介绍二尖瓣闭式扩张术后的瓣膜替换术经验。方法：我院自１９７７年１１月至１９９３年１２月期间共行二尖瓣闭式扩张术后瓣膜替换术２２９例（男１４８例，女８１例）。瓣膜替换时平均年龄４３．９５±６．６０岁。其中急诊手术５例，择期手术２２４例，两次手术间隔为１２．９６±６．７９年。均在低温体外循环下手术，其中二尖瓣替换术２０８例（９０．８３％）；二尖瓣及主动脉瓣双瓣替换术２１例（９．１７％）。结果：总手术死亡率７．４２％，１９８７年前死亡率为２３．６８％，而近３年死亡率仅０．８８％（１／１１３）。结论：掌握好手术时机；注重心肌保护；避免广泛游离心包粘连；采用右房、房间隔切口显露二尖瓣，连续缝合法替换二尖瓣，使手术时间缩短；以及正确的术后处理等，均是降低死亡率的重要因素。     

人工机械瓣膜替换术103例报告

本文叙述了人工机械瓣膜替换术１０３例，施行二尖瓣替换术６４例，主动脉瓣替换术６例，三尖瓣替换术５例，主动脉及二尖瓣双瓣膜替换术２８例。置入人工机械瓣膜１３１个。术后早期死亡５例，死亡率４．９％；晚期死亡６例。对广义的心肌保护、自体输血的临床应用、术中操作、术后晚期的死亡原因及预防等一些问题谈了自己的体会。     

重症感染性心内膜炎的外科治疗

目的 评价重症感染性心内膜炎手术治疗效果.方法 回顾性分析2003年1月至2007年6月手术治疗的复杂性心内膜炎患者33例临床资料,均为原发性心内膜炎,其中感染侵犯二尖瓣16例、主动脉瓣11例、二尖瓣和主动脉瓣6例.术中发现瓣叶严重毁损27例、主动脉瓣周脓肿1例、均有瓣膜赘生物形成.脓肿清除后遗留残腔采用间断褥式缝合1例、主动脉瓣替换术11例,二尖瓣替换术16例,主动脉瓣及二尖瓣双瓣替换术6例.结果 早期无死亡,术后3个月心功能(NYHA分级)恢复Ⅰ级33%(11/33)、Ⅱ级66%(22/33).结论 重症心内膜炎瓣膜及瓣环受损重,积极手术,彻底清除赘生物,病灶创面的恰当处理是影响手术本身能否成功以及术后近期效果的关键.     

Prediction of operative mortality after valve replacement surgery.

OBJECTIVES: We sought to develop national benchmarks for valve replacement surgery by developing statistical risk models of operative mortality. BACKGROUND: National risk models for coronary artery bypass graft surgery (CABG) have gained widespread acceptance, but there are no similar models for valve replacement surgery. METHODS: The Society of Thoracic Surgeons National Cardiac Surgery Database was used to identify risk factors associated with valve surgery from 1994 through 1997. The population was drawn from 49,073 patients undergoing isolated aortic valve replacement (AVR) or mitral valve replacement (MVR) and from 43,463 patients undergoing CABG combined with AVR or MVR. Two multivariable risk models were developed: one for isolated AVR or MVR and one for CABG plus AVR or CABG plus MVR. RESULTS: Operative mortality rates for AVR, MVR, combined CABG/AVR and combined CABG/ MVR were 4.00%, 6.04%, 6.80% and 13.29%, respectively. The strongest independent risk factors were emergency/salvage procedures, recent infarction, reoperations and renal failure. The c-indexes were 0.77 and 0.74 for the isolated valve replacement and combined CABG/valve replacement models, respectively. These models retained their predictive accuracy when applied to a prospective patient population undergoing operation from 1998 to 1999. The Hosmer-Lemeshow goodness-of-fit statistic was 10.6 (p = 0.225) for the isolated valve replacement model and 12.2 (p = 0.141) for the CABG/valve replacement model. CONCLUSIONS: Statistical models have been developed to accurately predict operative mortality after valve replacement surgery. These models can be used to enhance quality by providing a national benchmark for valve replacement surgery.     

Six-year experience with the St. Jude Medical prosthesis: early and late results of 540 valves in 462 patients

From July 1978 to June 1984, 540 St. Jude Medical valve prostheses were implanted in 462 adult patients. Overall operative mortality was 4.8% (22/462): 5.7% after aortic valve replacement (AVR) (8/140); 3.3% after mitral valve replacement (MVR) (8/244); and 7.7% after aortic and mitral valve replacement (DVR) (6/78). There were 16 late deaths among 440 operative survivors; six (38%) were valve related. The actuarial survival rate at six years was 94.5% in AVR and 93.5% in MVR. At five years it was 91.6% in DVR. The freedom from valve-related death at six years after AVR, MVR and at five years after DVR was 97.8%, 98.6% and 95.8%, respectively. The incidence of valve-related complications (expressed as %/patient-year (number of events] was as follows: thrombo-embolism (AVR 0.7 (2), MVR 2.0 (13), DVR 2.8 (5], valve thrombosis (AVR 0.3 (1), MVR 0.2 (1), DVR 0 (0], prosthetic valve endocarditis (AVR 0.3 (1), MVR or DVR 0 (0]. There were no cases of primary structural failure, serious anticoagulant-related hemorrhage or clinical event of hemolysis. The incidence of all valve-related complications in AVR, MVR and DVR was 1.3, 2.2 and 2.8%/pt-yr, respectively. The freedom from thrombo-embolism at six years after AVR and MVR and at five years after DVR were 91.4%, 92.4% and 88.7%, respectively. Re-operation was performed in only one patient with MVR because of valve thrombosis (0.2%/pt-yr after MVR, overall 0.1%/pt-yr). These results indicate that St. Jude Medical prosthesis has provided a satisfactory performance with acceptable risks of late complications in patients who were properly anticoagulated during six-year follow-up period.     

Clinical experience with the Carpentier-Edwards porcine bioprosthesis: short-term results (from 2 to 4.5 years)

All patients undergoing a heart valve replacement with a glutaraldehyde Carpentier-Edwards xenograft from April 1978 through December 1980 were reviewed. This analysis included 189 patients: 117 having a mitral valve replacement (MVR), 45 having an aortic valve replacement (AVR), and 27 having mitral and aortic valve replacements (MAVR). Out of 174 patients discharged from the hospital, one was lost to follow-up and is excluded from the analysis. There were 11 late deaths, which represent an incidence of 1.89% per patient-year for the MVR (6/106), 0.83% per patient-year for the AVR (1/41), and 5.83% per patient-year for the MAVR (4/26). There were 6 instances of infective endocarditis (4 MVR, 2 MAVR), which represent a linearized incidence o 1.26% and 2.91% per patient-year for the MVR and MAVR respectively. All were successfully treated with medication. There were 10 thromboembolic events in 7 patients (6 MVR had 9 events and 1 AVR had 1 event). This represents a linearized incidence of 2.84% and 0.83% per patient-year for MVR and AVR, respectively. Primary tissue failure was observed in 3 patients (2 MVR, 1 MAVR), who required reoperation for explantation of the mitral valves. This represents an overall linearized incidence of mitral failures of 0.78% per patient-year. The probability of being free from primary tissue failure is 95.9 +/- 4.9% for all mitral prostheses at 4.5 years of follow-up. These current results indicate that the Carpentier-Edwards porcine xenograft valve can be considered as a valid alternative for heart valve replacement.     

Five-year follow up of the ATS mechanical heart valve

BACKGROUND AND AIM OF THE STUDY: Between January 1, 1997 and December 31, 2001, a total of 342 patients underwent aortic valve replacement (AVR) or mitral valve replacement (MVR) with the ATS Medical prosthesis. The initial three-year phase of this study took place under a United States Food and Drug Administration-approved investigational device exemption study. The study aim was to determine the incidence of valve-related events in up to five years of follow up after valve implantation, and to assess patient disturbance from valve noise. METHODS: Patients were consecutively enrolled to undergo AVR or MVR with the ATS prosthesis. Follow up studies were conducted by patient questionnaire and/or telephone call. Follow up was 96% complete. AVR was conducted in 246 patients (80 with coronary bypass), and MVR in 96 patients (29 with coronary bypass). RESULTS: The overall operative mortality was 2.6% (n = 9; AVR 3.2%, n = 8; MVR 1.0%, n = 1), with two deaths being valve-related (0.6%). In 878 patient-years (pt-yr) of follow up (613 pt-yr for AVR; 265 pt-yr for MVR) there were an additional 22 deaths. Five deaths (0.6%/pt-yr) were valve-related: two were neuroembolic (both MVR), one from endocarditis (AVR), and two from bleeding events (both AVR). Late valve-related complications (>30 days) included 17 episodes of major bleeding (11 AVR, 1.8%/pt-yr; six MVR, 2.3%/pt-yr), five permanent neuroembolic events (four AVR, 0.7%/pt-yr; one MVR, 0.4%/pt-yr); 16 transient neuroembolic events (10 AVR, 1.6%/pt-yr; six MVR, 2.3%/pt-yr); three transient peripheral emboli (two AVR, 0.3%/pt-yr; one MVR, 0.4%/pt-yr); four paravalvular leaks (two AVR, 0.3%/pt-yr; two MVR, 0.8%/pt-yr); and one episode of valve thrombosis (MVR, 0.4%/pt-yr; AVR, 0%/pt-yr). Reoperation was required in two patients: one AVR (paravalvular leak, 0.2%/pt-yr) and one MVR (replacement due to thrombosis, 0.4%/pt-yr). CONCLUSION: These results indicate that intermediate-term results with the ATS mechanical prosthesis continue to be excellent, though further long-term follow up is warranted.     

Clinical evaluation of the carbomedics prosthesis: experience at providence health system in Portland

BACKGROUND AND AIMS OF THE STUDY: This study details the authors' experience with the CarboMedics bileaflet mechanical prosthesis, and assesses the valve's efficacy in terms of early mortality and long-term morbidity. METHODS: Between July 1994 and December 2000, a total of 696 CarboMedics valves was implanted in 616 patients. Aortic valve replacement (AVR) was performed in 350 (57%) patients, mitral valve replacement (MVR) in 161 (26%), double (aortic + mitral) valve replacement (DVR) in 79 (13%), and other procedures in 26 (4%). RESULTS: There were 32 operative deaths. Operative mortality was 4.3% for AVR, 6.8% for MVR, and 7.6% for DVR. Linearized rates for late death were 3.4%/patient-year (pt-yr), 5.5%/pt-yr and 7.7%/pt-yr for AVR, MVR and DVR, respectively. Survival at five years was 80.1% for AVR, 73.0% for MVR, and 64.6% for DVR (p = 0.004). Freedom from reoperation at five years was 97.6% for AVR, 98.1% for MVR, and 94.1% for DVR (p = 0.718); freedom from thromboembolism at five years was 96.3% for AVR, 98.6% for MVR, and 88.3% for DVR (p = 0.04). Linearized rates of late thromboembolism were 0.7%/pt-yr, 0.4%/pt-yr and 2.3%/pt-yr, respectively. Freedom from PVE at five years was 98.4% for AVR, 97.0% for MVR, and 89.7% for the DVR group (p = 0.172). Linearized rates of PVE were 0.5%/pt-yr, 0.9%/pt-yr and 1.8%/pt-yr, respectively. Freedom from anticoagulant-related bleeding at five years was 98.0% in the AVR group, 97.8% in the MVR group, and 88.3% in the DVR group (p <0.001); linearized rates of this event were 0.4%/pt-yr, 0.6%/pt-yr and 3.2%/pt-yr, respectively. One valve thrombosis was found after MVR, and another in the mitral position after DVR. CONCLUSION: Early and intermediate-term follow up of the CarboMedics prosthesis indicates that the clinical performance of this valve is satisfactory, and results are comparable with those obtained for other mechanical valves.     

Mechanical aortic and mitral valve replacement in infants and children

BACKGROUND: The aim of this study was to evaluate early and late outcomes after mechanical systemic heart valve replacement in pediatric patients. METHODS: Between October 1981 and December 2003, 32 children (mean age 7.2 +/- 5.4 years; 4 months - 15.9 years) underwent mechanical mitral (MVR, n = 17), aortic (AVR, n = 13) or double valve replacement (DVR, n = 2) with St. Jude Medical valves. Twenty-two patients (69 %) had undergone previous cardiac surgery. Anticoagulation self-management was used since 1995. RESULTS: The operative mortality was 3.1 %. Perioperative complications were complete heart block (n = 5), ventricular fibrillation (n = 1) and myocardial infarction (n = 1) and were exclusively related to patients with MVR. Mean calculated valve size ratio (geometric prosthesis orifice area/normal valve size area) was 1.72 (1.07 - 2.85) for AVR and 1.4 (0.88 - 3.12) for MVR. Mean follow-up was 9.1 +/- 6.6 years (range 0.4 - 23.2 years, cumulative 283 patient-years). There were two late deaths in patients with MVR. Actuarial survival after 10 years was 93.8 %. Late complications were endocarditis (n = 2), minor hemorrhagic event (n = 1), and stroke (n = 1). Anticoagulation self-management is well accepted by all patients/parents. Overall 10-year freedom from any anticoagulation-related adverse event with phenprocoumon was 89.1 % (1.2 %/patient year). Nine patients required reoperations: redo-MVR (outgrowth of prostheses (n = 3), pannus overgrowth (n = 2), closure of paravalvular leak after AVR (n = 2), partial aortic valve thrombosis (n = 1) and redo-DVR (n = 1 for endocarditis). Freedom from reoperation after 10 years was 80.9 %. CONCLUSIONS: Mechanical valve prostheses are a valuable option for left-sided heart valve replacement in pediatric patients. Perioperative morbidity was exclusively related to patients with MVR. Oversizing was often possible to avoid early reoperation for outgrowth. The operative mortality and long-term morbidity are acceptable. Anticoagulation self-management is safe and well accepted.     

Low-dose oral anticoagulation and antiplatelet therapy with St. Jude Medical heart valve prosthesis

BACKGROUND AND AIM OF THE STUDY: Since 1986, the St. Jude Medical (SJM) mechanical heart valve prosthesis has been implanted in patients at the authors' institution. We present our experience of low-dose oral anticoagulation and antiplatelet therapy following SJM valve implantation. METHODS: Among 2,585 patients (mean age 40.3 +/- 13.5 years) living in a rural environment, 865 underwent aortic valve replacement (AVR), 1,231 mitral valve replacement (MVR) and 489 double valve replacement (DVR). All patients received 2.5 mg/day warfarin and a combination of antiaggregation therapy (dypridamole 3 x 75 mg/day plus aspirin 100 mg/day), irrespective of their prothrombin time and cardiac rhythm. RESULTS: Postoperatively, 139 adverse events occurred (51 in AVR patients, 58 in MVR, 30 in DVR). Operative mortality rate was 5.9%, 4.7% and 6.1%, respectively, in the three groups (overall mortality rate 5.4%). The most frequent cause of operative mortality was low cardiac output. During follow up, there were 88 anticoagulant hemorrhages (1.2%/patient-year (pt-yr)), 11 paravalvular leaks (0.2%/pt-yr), 52 thromboembolisms (0.7%/pt-yr), 60 mechanical valve thromboses (0.8%/pt-yr) and 78 reoperations (1.1%/pt-yr). These complications occurred in 101 patients after AVR, in 125 after MVR, and in 63 after DVR (4.2%, 3.7% and 4.6% per pt-yr, respectively). Patient age (p = 0.0004), concomitant surgery (p = 0.0017) and late valve-related complications (p = 0.0159) were statistically significant mortality factors after AVR. Previous surgery was a significant risk factor for operative mortality after MVR (p <0.05). Female gender (p = 0.0059) and age (p = 0.017) were significant risk factors for operative mortality after DVR (p <0.01). CONCLUSIONS: Following implantation of the St. Jude Medical mechanical heart valve prosthesis, a fixed dose of 2.5 mg/day warfarin and combined dipyridamole/aspirin provided satisfactory results in terms of thrombosis, embolism and bleeding.     

Eight year experience with the Bjork-Shiley prosthesis in 833 patients

Between December 1970 and June 1978, 833 patients were operatedupon for isolated mitral valve replacement (MVR: 361 patients),isolated aortic valve replacement (AVR: 345 patients) and aorticplus mitral valve replacement (DVR: 127 patients) by use ofthe Björk-Shiley valve. Operative mortality for the entireseries was 15%. The five year survival rate, including operativemortality, calculated by the actuarial method was 81.4% forMVR, 73.1% for AVR and 66.8% for DVR. The five year survivalrate of operative survivors was 94.9% for MVR, 85% for AVR and83.2% for DVR. The five year complication-free survival rate(death/removal/embolus-free survival rate) including operativemortality was 69.7% for MVR, 71.8% for AVR and 62.8% for DVR.The postoperative hemodynamic result was evaluated in 58 consecutivepatients with AVR and DVR. End-diastolic volume fell after operationfrom 161 to 104 ml/m² in AVR and from 156 to 103 ml/m² in DVR.Ejection fraction increased from 54 to 65% in AVR and from 50to 61% in DVR. We conclude: (1) actuarial analysis of prosthesis related deathand complications suggests that the Björk-Shiley valveis an excellent choice when using a mechanical device; (2) asignificant improvement of left ventricular function resultsafter Björk-Shiley valve implantation.     

Carpentier-Edwards bioprosthesis: a 7-year follow-up in 361 patients

Three hundred sixty-one patients undergoing heart valve replacement with Carpentier-Edwards bioprostheses (CE) were evaluated: 169 patients underwent replacement of the mitral valve (MVR), 124 of the aortic valve (AVR), one of the tricuspid valve (TVR) and 67 of 2 or more valves (mVR). A total of 420 CEs were implanted. Overall operative mortality was 4.7% (7.1 for MVR, 1.6 for AVR, 4.5 for mVR). Early complications included hemorrhage (5 cases), thromboembolism (one case), paraprosthetic leak (one case). Actuarial survival rates at 5 years were computed for overall deaths, cardiac deaths and prosthetic deaths. In the 3 subgroups these 3 rates were respectively 78.7 +/- 5.6%, 82.9 +/- 5.4%, 96.4 +/- 1.6% for MVR, 88.9 +/- 3.3%, 94.2 +/- 2.3%, 98.7 +/- 1.3% for AVR, and 82.3 +/- 5.9%, 88.3 +/- 5.1%, 98.5 +/- 1.5% for mVR. Actuarial freedom from prosthetic complications at 7 years was 59.6 +/- 7.5%, 78.1 +/- 4.1% and 61.9 +/- 8.0% for MVR, AVR and mVR patients. Thromboembolism-free rates were 87.2 +/- 3.9% and 99.2 +/- 0.8% for MVR and AVR, while the thromboembolic linearized rate was 2.8% per patient-year and instantaneous risk of thromboembolism was 4.1% at one and instantaneous risk of thromboembolism was 4.1% at one year for MVR. Anticoagulant-related hemorrhage linearized occurrence was 1.0%, 1.2% and 0.8% per patient-year among the 3 subgroups. Prosthetic endocarditis occurred in 12 patients with a linearized rate of 1.1% per patient-year. Eleven of these patients were treated successfully. Three episodes of primary tissue failure were recorded (0.2% linearized rate per year, instantaneous risk 3.5% at the sixth year).(ABSTRACT TRUNCATED AT 250 WORDS)     

Ten-years' clinical experience with the Sorin Pericarbon valve

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate 10 years' results obtained with the Pericarbon pericardial bioprosthesis. METHODS: Between September 1988 and December 1997, 277 patients (mean age 75.8 +/- 8.5 years) received a total of 287 Pericarbon pericardial valves. Of these patients, 224 (80.8%) underwent single aortic valve replacement (AVR) and 39 single mitral valve replacement (MVR); one patient had a tricuspid valve replacement (TVR), three patients had a pulmonary valve replacement (PVR) and 10 had both aortic and mitral valve replacement (DVR). Associated cardiac procedures were performed in 86 patients (31.0%), mainly coronary artery bypass graft (n = 71). Mean patient follow up was 4.9 +/- 2.6 years; total cumulative follow up was 1,221.4 patient-years. RESULTS: The overall hospital mortality rate was 10.1%. There were 50 late deaths (20.1%), four (1.6%) being valve-related. The patient survival rate at 10.8 years was 60.0 +/- 4.5% for AVR and 46.5 +/- 11.9% for MVR. Freedom from valve-related death at 10.8 years was 97.6 +/- 1.1% for AVR and 100% for MVR. Freedom from structural valve deterioration was 96.1 +/- 2.7% for AVR and 100% for MVR. Freedom from embolic events was 96.0 +/- 1.5% for AVR and 100% for MVR. In total, 16 patients needed reoperation, three for stenosis due to dystrophic calcification, six for endocarditis and seven for paravalvular leak. Freedom from reoperation was 89.9 +/- 4.2% for AVR and 80.6 +/- 7.3% for MVR. CONCLUSION: These results show that, over a period of up to 10 years, the Pericarbon pericardial bioprosthesis constitutes an excellent and safe replacement valve.