[Effect of prosthetic heart valve replacement on the natural course of isolated mitral and aortic as well as multivalvular diseases. Clinical results in 783 patients up to 8 years following implantation of the Björk-Shiley tilting disc prosthesis].
[Effect of prosthetic heart valve replacement on the natural course of isolated mitral and aortic as well as multivalvular diseases. Clinical results in 783 patients up to 8 years following implantation of the Björk-Shiley tilting disc prosthesis].
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[人工心脏瓣膜置换术对 783 名患者植入 Björk-Shiley 倾斜椎间盘假体后长达 8 年的临床结果对孤立性二尖瓣和主动脉以及多瓣膜疾病的自然病程的影响]。
DOI：
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发表时间：
1983
期刊：
影响因子：
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通讯作者：
W. Bircks
中科院分区：
文献类型：
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作者：
D. Horstkotte;F. Loogen;G. Kleikamp;H. Schulte;H. Trampisch;W. Bircks
为了确定人工瓣膜置换术对NYHA III级和IV级二尖瓣、主动脉瓣和双瓣疾病自然病程的影响，将359例Björk-Shiley二尖瓣假体（BSM）、317例主动脉瓣假体和107例双瓣假体患者的进展与接受药物治疗的患者进行了比较。在最后一组患者中，在1968-1976年期间建议进行瓣膜置换术，但由于各种原因没有进行。BSM组8年后的累积生存率为77%，但药物治疗组仅为32%（p <0.0001）。术后1年，70%的BSM患者表现出相当于一个NYHA分级的改善，并且大多数患者在5年后仍然明显。在二尖瓣关闭不全患者中，手术治疗组的累积生存率为86%，药物治疗组为32%（p <0.00001）。在二尖瓣狭窄患者中，这些累积生存率的差异甚至更明显（p <0.000001），手术治疗的患者为85%，药物治疗的患者为10%。BSA组的临床改善平均为1.5 NYHA分级。二尖瓣和二尖瓣病变患者的5年生存率为32%，而双瓣置换术患者的5年生存率为67%（P <0.005）。双瓣置换术后的临床改善与二尖瓣置换术后相似。对于单纯二尖瓣或二尖瓣病变以及NYHA III和IV级双瓣病变患者，人工心脏瓣膜置换术显著延长了患者的寿命。即使在研究的早期，当手术死亡率相对较高时，手术治疗组的生存率也明显高于保守治疗组，这在随访期的早期阶段就已经很明显了。二尖瓣和双瓣疾病的功能能力改善和症状缓解相当于约1个NYHA分级的差异，二尖瓣疾病的NYHA分级相当于约1.5个NYHA分级的差异。
In order to establish the influence of prosthetic valve replacement on the natural course of mitral, aortic, and double-valve disease of NYHA class III and IV, the progress of 359 patients with Björk-Shiley mitral-valve prostheses (BSM), 317 with aortic valve prostheses, and 107 with double valve prostheses was compared with that of patients who had been treated medically. In this last group of patients, valve replacement had been recommended in the period 1968-1976, but for various reasons had not been carried out. Cumulative survival rates after 8 years were 77% for the BSM group, but only 32% for the medically treated group (p less than 0.0001). One year after operation, 70% of the BSM patients showed an improvement equivalent to one NYHA class, and in the majority this was still apparent after 5 years. In patients with aortic-valve incompetence, cumulative survival rates were 86% for the surgically treated group and 32% for the medically treated group (p less than 0.00001). In aortic-valve stenosis, these differences of cumulative survival rates were even more pronounced (p less than 0.000001), and were calculated to be 85% in surgically treated and 10% in medically treated patients. Clinical improvement in the BSA group averaged 1.5 NYHA classes. The 5-year survival rate for the patients with mitral and aortic-valve disease was 32%, while following doublevalve replacement it was 67% (p less than 0.005). Clinical improvement after double-valve replacement was similar to that following mitral-valve replacement. Prosthetic heart-valve replacement significantly prolongs life in patients with isolated mitral- or aortic-valve lesions as well as in patients with double-valve disease of NYHA classes III and IV. Even in the early years of the study, when the operative mortality was relatively high, the surgically treated groups had a significantly higher survival rate than the conservatively treated groups, and this was already apparent at an early stage in the follow-up period. Improvement of functional capacity and relief of symptoms amount to a difference of approximately one NYHA class in mitral and double-valve disease and of approximately 1.5 NYHA classes in aortic-valve disease.