Isolated pulmonary valve replacement: analysis of 27 years of experience
Isolated pulmonary valve replacement: analysis of 27 years of experience
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DOI：
10.1007/s10047-008-0413-8
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发表时间：
2008-09-01
影响因子：
1.3
通讯作者：
Tominaga, Ryuji
中科院分区：
文献类型：
--
作者：
Tokunaga, Shigehiko;Masuda, Munetaka;Tominaga, Ryuji
本研究的目的是调查使用异种生物瓣膜或机械瓣膜进行孤立性肺动脉瓣置换术的长期结果。回顾了1977年至2004年间在九州大学医院进行的24例孤立性肺动脉瓣置换术。接受Rastelli手术的患者被排除在本研究之外。18例患者使用生物瓣膜，6例使用机械瓣膜。无手术死亡。2例机械瓣膜患者因瓣膜血栓形成需要再次肺动脉瓣置换术。植入生物瓣的患者术后无需再次置换。心胸比率由术前的60.3%提高到术后的55.4%（P <0.05），纽约心功能分级由术前的2.0级提高到术后的1.1级（P <0.05）。15年的精算生存率为92.3%。15年时，生物瓣膜组和机械瓣膜组的无瓣膜相关事件率分别为85.7%和66.7%，无显著差异。使用生物瓣膜或机械瓣膜进行隔离肺动脉瓣置换术可以安全地进行，并显示出令人满意的长期结果。机械瓣膜组的瓣膜血栓形成率较高。如果无法获得同种移植物，则建议使用生物瓣膜进行肺动脉瓣置换术。
The aim of this study was to investigate the longterm results of isolated pulmonary valve replacement using xenobioprostheses or mechanical valves. Twenty-four cases of isolated pulmonary valve replacement carried out at Kyushu University Hospital between 1977 and 2004 were reviewed. Those undergoing Rastelli's operation were excluded from this study. Bioprostheses were used in 18 patients and mechanical valves in 6. There were no operative deaths. Two patients with mechanical valves needed repeat pulmonary valve replacement due to thrombosed valves. The patients with bioprostheses had no need of repeat replacement postoperatively. The cardiothoracic ratio significantly improved from 60.3% preoperatively to 55.4% postoperatively (P < 0.05), and the New York Heart Association (NYHA) class significantly improved from 2.0 preoperatively to 1.1 postoperatively (P < 0.05). The actuarial survival rate at 15 years was 92.3%. The valve-related event-free ratio at 15 years was 85.7% in the bioprosthesis group and 66.7% in the mechanical valve group, with no significant difference. Isolated pulmonary valve replacement with bioprostheses or mechanical valves can be safely done and showed satisfactory long-term results. The mechanical valve group demonstrated a high ratio of thrombosed valves. A bioprosthesis is recommended for pulmonary valve replacement if a homograft is not available.