Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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A Clinical Experience of Mitral Valve Replacement

승모판막 치환술의 임상적 고찰

  • 김종원 (부산대학교 의과대학 흉부외과학교실) ;
  • 황수희 (부산대학교 의과대학 흉부외과학교실)
  • Published : 1996.12.01
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Abstract

To assess the long-term results of mitral valve replacement, we reviewed our cases of the 374 patients undergoing mitral valve replacement between March 1982 to February 1992 There were 159 male and 215 female and mean age was 37.8 years. There were 24 hospital deaths(6.4%);the most commonly from low cardiac output syndrome(12 deaths). We used 314 mechanical valves and 60 tissue valves. Most of all were anticoagulated with coumadin maintaining target level of 1.5~3.0 INR of prothrombin time. Follow up was 94% complete(2270 patient-years). There were 12 late deaths 3 due to hemorrhage, 3 due to cerebral embolism and 6 from Overall actuarial survival including hospital mortality, was 82.3% after 10 years of operation Linealized rates of late complication events are follows thromboembolism, 1.3% per patient-year; anti coagulant related hemorrhage, 0.5% per patient year. We analyzed the factors of favorable effect to postoperative course were preoperat ve clinical status including NYHA class, first operation, valve apparatus preservating operation technique, not biggest size of prosthetic valve.

부산대학교병원 흉부외과에서 1982련 3월부터 1992년 2월까지 승모판막치환술을 받은 환자들을 대상으로하여 승모판막치환술 후 장기성적에 대한 분석을 시행하였다. 환자 중 남자는 159명이었고 여자는 215명이 었으며 평균연령은 31.8세였다. 병원사망율은 24례(6.4%)였고 가장 흔한 원인은 저심 박출증후군으로 12례였다. 치환된 판막은 기계 판막이 314개, 조직판막이 60개였고 재치환술을 시행한 경우는 31례로 모두 기계판막을 사용하였다. 거의 전환자에게 coumadin을 투여하여 항응고요법을 시행하였고 국제정상화비(INR)가 1.5~3.0이 되도록 하였다. 생존례의 추적관찰은 93%에서 가능하였고 2270환자-년이었다. 만기 사망례는 12례였는데 그 중 3례가 뇌출혈, 3례가 뇌혈관전색으로 사망하였다. 병원 사망율을 포함한 만기 생존율은 술후 10년에 82.3%였다. 만기합병증의 발생율은 전색증이 1.3%환자-년, 항응고요법과 관련된 출혈성함병증이 1.3%환자-년이었다. 술후 예후에 좋은 영향을 미칠 것으로 생각되는 요인으로는 뉴욕심장협 회의 심기능평가를 포함한 술전 환자상태, 첫 수술인 경우, 판막부속기 보전의 수술법 및 너무 크지 않은 기계판막\ulcorner 사용하지 않는 것으로 나타났다.

Keywords

References

  1. Heart valve replacement and further trends in cardiac surgery Rabago,G.
  2. J Thorac Cardiovasc Surg v.96 Guidelines for reporting morbidity and mortality after cardiac valvular operations Edmunts,L.H.;Clark,R.E.;Cohn,L.H.(et al.)
  3. Surgery of the chest(6th ed.) Acquired disease of the mitral valve Spencer,F.C.;Galloway,A.C.;Colvin,S.B.;Sabiston,D.C.
  4. Ann Thorac Surg v.43 St. Jude medical prosthesis : V alve related deaths and complications Arom,K.V.;Nicolloff,D.M.;Kersten,T.E.(et al.)
  5. Ann Thorac Surg v.24 Patientrelated risk factors a predictors of results following isolated mitral valve replacement Saloman,N.M.;Stinson,E.B.;Griep,R.B.;Shumway,N.E.
  6. Ann Thorac Surg v.27 Mitral valve replacement : a nine year follow up of the risk and survivals Chaffin,J.S.;Dragett,W.M.
  7. A thirteen-year experience v.23 The St. Jude medical Prostesis Ibrahim M.Hugh O;Cleland,J.(et al.)
  8. 대흉외지 v.23 승모판막치환술후 조기사망의 술전 및 술후 위험인자에 대한 고찰 박승규;이종수;성시찬;김종원
  9. J Thorac Cardiovasc Surg v.47 Mitralvalve replacement with preservation of papillary muscles and chordae tendinae Lillehei,c.w.;Levy,M.j.;Bonnabeau,R.C.
  10. Scand J Thorac Cardiovasc Surg v.28 Mitral valve implantation with native mitral valve appretus Dubiel,T.W.;Borowiec,J.W.;Manting,F.
  11. 대흉외지 v.23 승모판질환에서 승모판대치술시 승모판후엽 및 건삭보존의 효과 조강래;김종원
  12. Ann Thorac Surg v.57 no.3 Twelve years experience with St. Jude Medical Valve Prosthesis Nakano,K.;Koyanagi,H.;Hashimoto,A.(et al.)
  13. 대흉외지 v.28 쎈트쥬드 대동맥판의 장기임상성적 김종환
  14. Ann Thorac Surg v.39 Risk of mitral valve replacement and mitral valve replacement with coronary artery Magovern,J.A.;Pennock,J.L.;Cambell,D.B.(et al.)
  15. J Card Surg v.9 no.Suppl Mitral valve replacement: Indications, Choice of valve prosthesis, results and long term morbidity of porcine and mechanical valves Jones,E.L.
  16. N Engl J Med. v.328 Veterans affairs cooperative study : A comparison of outcomes in men 11 years after heart valve replacement with a mechanical or bioprosthesis Hammermeister,K.E.;Sethi,G.K.;Henderson,W.G.(et al.)
  17. J Heart Valve Dis v.3 Guideline for prevention of thromboembolic events in valvular heart disease Gohike-Barwof,C.;Acar,J.;Burckhardtt,D.(et al.)
  18. J Heart Valve Dis v.4 Optimizatiion of oral anticoagulation for patients with mechanical heart valve prosthesis Piper,C.;Schulte,H.D.;Horskotte,D.
  19. Kyobu-Gekaa v.47 Anticoagulation for patients with mechanical heart valve replacement with special reference to international normalized ratio(INR) Chikada,M.;Jaeyu,K.;Kotsuka,Y.;Forose,A.
  20. Cardiol Clin v.9 Mitral valve repair versus replacement Yun,K.L.;Miller,D.C.