A prospective evaluation of 333 consecutive patients undergoing isolated mitral valve replacement between 1982 and 1985 was performed to identify the predictors of survival and valve failure. Follow-up between 2 and 6 years postoperatively (mean, 32 +/- 17 months) was 98% complete. Four prostheses were inserted to permit a prospective evaluation of alternative valves: Björk-Shiley mechanical (n = 118), Ionescu-Shiley pericardial (n = 146), Carpentier-Edwards porcine (n = 38), and Hancock pericardial (n = 31). Hospital mortality was 6%, and actuarial survival at 5 years was 74% +/- 5%. Multivariate Cox regression analysis identified advancing age (less than 40 years, 88% +/- 7%; greater than 70 years, 50% +/- 14%) and poor left ventricular function (ejection fraction less than 0.20, 62% +/- 17%; ejection fraction greater than 0.60, 80% +/- 7%) as independent predictors of postoperative survival. Freedom from structural valve dysfunction, prosthetic valve endocarditis, reoperation, and valve-related mortality and morbidity were 86% +/- 4%, 91% +/- 4%, 81% +/- 4%, and 72% +/- 5%, respectively, at 5 years. The actuarial incidence of valve failure was inordinately high with the Hancock pericardial valve (p less than 0.05). Freedom from thromboembolic events (78% +/- 8% at 5 years) was significantly lower in patients with poor ventricular function (ejection fraction (less than 0.20, 54% +/- 20%; ejection fraction greater than 0.60, 73% +/- 11%; p less than 0.05). Survival after mitral valve replacement was determined by age and left ventricular function. Premature failure of the Hancock pericardial valve resulted in an unacceptable rate of valve-related complications.

译文

:对1982年至1985年间连续333例接受二尖瓣置换的患者进行了前瞻性评估,以明确其生存率和瓣膜衰竭的预测因素。术后2至6年(平均32 /-17个月)的随访完成了98%。插入了四个假体,以对其他瓣膜进行前瞻性评估:Björk-Shiley机械式(n = 118),Ionescu-Shiley心包式(n = 146),Carpentier-Edwards猪(n = 38)和Hancock心包式(n = 31 )。医院死亡率为6%,5年的精算生存率为74%/-5%。多元Cox回归分析确定年龄提前(小于40岁,88%/-7%;大于70岁,50%/-14%)和左心室功能差(射血分数小于0.20,62%/-17%) ;射血分数大于0.60,80%/-7%)作为术后生存的独立预测指标。摆脱结构性瓣膜功能障碍,人工瓣膜心内膜炎,再次手术以及与瓣膜相关的死亡率和发病率分别为86%/-4%,91%/-4%,81%/-4%和72%/-5% ,在5年后。汉考克心包瓣膜的瓣膜衰竭的精算发生率异常高(p小于0.05)。心室功能较差的患者(射血分数(小于0.20,54%/-20%;射血分数大于0.60,73%/-11)时,无血栓栓塞事件(5年时为78%/-8%)显着降低%; p小于0.05)。二尖瓣置换术后的存活率由年龄和左心室功能决定,汉考克心包瓣膜过早衰竭导致瓣膜相关并发症的发生率不可接受。

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