Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Clinical Results of Aortic Valve Replacement

대동맥판 치환술의 임상 성적

  • Na, Guk-Ju (Dept.of Troracic and Cardiovascular Surgery. Medical school, Chonnam National University) ;
  • O, Jeong-U (Dept.of Troracic and Cardiovascular Surgery. Medical school, Chonnam National University) ;
  • An, Byeong-Hui (Dept.of Troracic and Cardiovascular Surgery. Medical school, Chonnam National University) ;
  • Kim, Sang-Hyeong (Dept.of Troracic and Cardiovascular Surgery. Medical school, Chonnam National University)
  • 나국주 (전남대학교 의과대학 흉부외과학교실) ;
  • 오정우 (전남대학교 의과대학 흉부외과학교실) ;
  • 안병희 (전남대학교 의과대학 흉부외과학교실) ;
  • 김상형 (전남대학교 의과대학 흉부외과학교실)
  • Published : 1997.02.01
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Abstract

From August 1986 until June 1995, single aortic valve replacement was performed in 65 patients at the Chonnam National University Hospital. worthy-eight were male and 17 were female patients, ranging from 19 to 68 years of age(median : 43 years). The causes of the valve lesions were rheumatic in 29 patients (44.6%), bicuspid aortic valve in 6 patients (6.2%), endocarditis in 6 patients(6.2%), unknown in others. Concomitant surgical procedures were performed in 10 patients : repair of congenital defect in 5, pericardiectomy in 1, coronary artery bypass grafting in 1, noncoronary sinus plication in 1, Valsalva sinus aneurysmectomy in 1, subaortic membrane resection in 1 Used valves were 51. Jude-Medical valve in 42, Duromedics valve in 22, Bjork-Shiley valve in 2, Carpentier-Edward valve in 1. There were 3 hospital deaths (4.6%), and 2 late deaths (3.2%). Follow-up was 95.2% complete. The 10-year acturlal survival rate was 85.3%. Postoperative complications were low cardiac utput in 8, arrythmia in 5, valve related hemolysis in 1, cerebral infarction in 1, and gastrointestinal bleeding in 2. Reoperation was performed in 4 for surgical bleeding, in 3 for paravalvular leak. The mean improvement in New York Heart Association functional class is from 2.79 $\pm$ 0.66 preoperatively to 1.25 $\pm$ 0.49 postoperatively(p < 0.001) The change of cardiothoracic ratio from preoperative to postoperative is 0.57 $\pm$ 0.06 to 0.54 $\pm$ 0.05 (p < 0.05). The left ventricular ejection fraction change is not significant perioperatively. There are no mechanical failures. This early and intermediate-term follow-up suggests that in adults in whom valve repair is not possible, the mechanical valve is a reliable and durable prosthesis with good hemodynamic function and a low rate of thromboembolic event.

전남대학교병원 흉부외과학교실에서는 1986년 8월 부터 1995년 7월 까지 65례의 대동맥판치환술을 경험하였다. 48명이 남자였고 17명의 환자가 여자였으며 19세에서 68세의 연령분포를 보였다. 판막질환의 원인은 류마티성 질환이 29례 (44.6%), 선천성 판막질환이 6례 (6.2%), 심내막염이 6례 (6.2%) 등을 보였다 동반된 수술은 10례에서 있었는데 5례가 선천성 심장 질환의 교정술이었고심막절제술 1례, 관상동맥우회로 조성술 1례, 발살바 동맥동 수술 2례, 대동맥 판막하막 절제술이 1례 등이었다. 사용된 판막은 St. Jude-Medical판이 42개, Duromedics판막이 22개, Bjork-Shiley판막이 2개, Carpentier-Edward판막 이 1개 있었다. 병원내 사망은 3례(4.6%)있었고 만기사망이 2례(3.2%)있었다. 수술후 사망례를 제외하고 100%의 환자에서 추적 관리가 되었고 10년 생존율은 85.3%를 보였다. 술후 합병증은 저심박출증이 8례, 부정맥이 5례, 기계판막과 관련된 용혈이 1례 있었다. 수술후NYHA기능분류는 수술전 2.79$\pm$ 0.66에서 수술후 1.25 $\pm$ 0.49로 개선되었고 단기 및 중장기 추적 조사 결과 우수한 기계판의 혈역학적 동태를 보였고 혈전증의 발생율은 아주 낮았다.

Keywords

References

  1. Ann Thorac Surg v.46 Gaidline for Reporting Morbidity and Mortality after Cardiac Valve Operation Henry Edmunds L;Clark RE;Cohn LH(et al.)
  2. J Thorac Cardiovsc Surg v.97 Primary isolated aortic valve replacement: early and late result Lytle BW;Cosgroove DM;Yaylor PC(et al.)
  3. Am J Cardiol v.51 Morphologic features of the normal and abnormal mitral valve Roberts WC
  4. Pathology of Cardiac valves Davies JJ
  5. 대흉외지 v.28 승모판 치환술의 임상성적 나국주;김상형;김광휴
  6. Ann Intern Med v.69 Obstruction to left ventricular outflow Morrow AB;Roberts WC;Ross J(et al.)
  7. Circulation v.61 no.SUP. Aortic stenosis Ross J;Braunwald E
  8. Am J Cardiol v.19 Natural history of severe acquired valvular aortic stenosis Frank S;Ross J
  9. N Engl J Med v.188 Surgery for acquired valvular heart disease Kirklin JW;Pacifico AD
  10. 대흉외지 v.28 쎈트쥬드 대동맥판막의 장기임상성적 김종환
  11. Circulation v.61 Observation on the optimum time for operative intervention for aortic regulgitation I Henry WL;Bonow RO;Borer JS(et al.)
  12. Circulation v.61 Observation on the ooptimum time for operative intervention for aortic regulgitation Ⅱ Henry WL;Bonow RO;Rosing DR;Epstein SE
  13. Am J Cardiol v.42 Exercise induced left ventricular dysfunction in symptomatic and asymptomatic pationts with aortic regulgitation Boere JS;Bacharch SL;Green MV(et al.)
  14. J Thorac Cardiovasc Surg v.111 Aortic valve preservation in acute type A dissectiion : is it sound Ludwig K;Enrico L;Mario L(et al.)
  15. J Thorac Cadiovasc Surg v.88 Early and late risk of aortic valve replacement Cohn LH;Allred EN;DiSesa VJ;Sawtelle K;Shemin RJ;Collins JJ
  16. J Thorac Cardiovasc Surg v.94 Comparative analysis of mechanical and bioprosthetic valve after aortic valve replacement Borkon AM;Soule LM;Baughman(et al.)