대상 대상및방법 - 수술방법 Table 1. Demographic and clinical characteristics Sex Characteristic MVR n166 AVR n99 Male Female Age mean, year

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1 Original Articles Korean Circulation J 22;327: Omniscience 인공심장판막삽입후 8 년간 추적관찰에대한결과보고 김정경 1 황흥곤 2 Results of Eight-Year Follow-Up of Omniscience Cardiac Prosthetic Valve Jeong Kyung Kim, MD 1 and Hweung Kon Hwang, MD 2 1 Department of Internal Medicine, DaeJeon Sun Hospital, DaeJeon, 2 Department of Internal Medicine, Sejong Hospital, Buchon, Korea ABSTRACT Background and ObjectivesThis study was performed to assess the morbidity and mortality of 311 patients implanted with at least one Omniscience prosthetic valve between January 1992 and January 2. Subjects and MethodsFollowing valve implantation all patients were followed up with routine interviews, physical examination and echocardiography. ResultsThe mean follow-up duration was standard error, SE years with a mean follow-up interval of SE months. The 311 patients received the following type s of valvemitral, aortic, both or tricuspid valve, in , , and 2.6 of cases, respectively. The cumulative follow up was patient-years pt-yr. Death occurred in eight patients.7/ pt-yr at linearized rate, and redo-operations were required in 27 patients 2.4/pt-yr due to valve failure. Actuarial freedom from all complication was SE. Freedom from pannus formation, paravalvular leak, or thromboembolism plus anticoagulant related bleeding were MVR/AVR / , MVR/AVR / , and MVR/AVR / respectively. ConclusionOur results with this prosthesis demonstrate relatively high incidences of valve related complication especially due to pannus formations and paravalvular leaks. We could reduce the incidences of mortality by earlier detection of complications, redo-operations and routine checks. Korean Circulation J 22;327: KEY WORDSHeart valve prosthesisprosthesis failurefollow-up studies. 서 - 론

2 대상 대상및방법 - 수술방법 Table 1. Demographic and clinical characteristics Sex Characteristic MVR n166 AVR n99 Male Female Age mean, year NYHA class mean Valve size mm Rheumatic % % Previous valve prosthesis failure % 8 8.% MVRmitral valve replacement, AVRaortic valve replacement, NYHANew York heart association 추적관찰및항응고제투여 - - 통계방법 - - 결과 사망및재수술환자군 589

3 합병증환자군 혈전증및항응고제관련된출혈 심내막염 용혈 - Fig. 2. Actuarial freedom from complication after MVR. MVRmitral valve replacement, SEstandard error. Fig. 1. Actuarial freedom from all complications. MVR mitral valve replacement, AVRaortic valve replacement. Table 2. Causes of redo-operation for Omniscience valve failure MVR n166 AVR n99 Total Paravalvular leak Pannus Valve thrombus 4 4 Endocarditis 1 1 Hemolysis MVRmitral valve replacement, AVRaortic valve replacement Fig. 3. Actuarial freedom from complications after AVR. p value represents comparing pannus with other two complications. AVRaortic valve replacement. 59 Korean Circulation J 22;327:

4 Paravalvular leak Fig. 4. Actuarial freedom from redo-operation. MVRmitral valve replacement, AVRaortic valve replacement. Pannus formation Table 3. Echocardiographic findings Finding Preop Postop Eight-year Ejection Fraction mean% * Valve angle Aortic valve pressure gradient mmhg of AVR patients Peak * Mean * Mitral valve pressure gradient mmhg of MVR patients Mean * Mitral valve area cm 2 of MVR patient * 2D planimetry Pressure half time * for fifty patients 48 years after operation, ASaortic stenosis, ARaortic regurgitation, MSmitral stenosis, MRmitral regurgitation Table 4. Incidence and linearized rate of complications and consequences Complications MVR n166 Events Linearized rate* AVR n99 Actuarial freedom Events Linearized rate* Actuarial freedom Thromboembolism and anticoagulant bleeding Prosthetic endocarditis Pannus formation Paravalvular leak Hemolysis Total Redo-operation %/pt-yrse, %SE, MVRmitral valve replacement, AVRaortic valve replacement 591

5 Table 5. Publications reporting long-term results of valve replacement 21-23) Follow-up time Complicationlinearized rate %/pt-yr Actuarial freedom from event %SE Reference Total Max Mean Total patients Age average Prosthesis TEARH HA Endocarditis Paravalvavular leak Pannus Late death Redooperation AVR Akins, Medtronic hall Arom, St. Jude 3.6 Fernandez, St. Jude Teijeira, Omniscience Kim, 2 present study Omniscience MVR Akins, Medtronic hall Arom, St. Jude Fernandez, St. Jude Teijeira, Omniscience Kim, 2 present study Omniscience Our follow-up duration was eight years. no data from authors, TEthromboembolism including valve thrombosis, ARHanticoagulant related hemorrhage 592 Korean Circulation J 22;327:

6 심초음파소견 - 고찰

7 요약 배경및목적 : 방법 : 결과 : Korean Circulation J 22;327:

8 - 결론 : 중심단어 REFERENCES 1) Mikhail AA, Ellis R, Johnson S. Eighteen-year evolution from the lillehei-kaster valve to the omni design. Ann Thorac Surg SupplS ) Bjork VO. The optimal opening angle of the bjork-shilley tilting disc valve prosthesis. Scand J Thorac Cariovasc Surg ) Esper E, Ferdinand FD, Aronson S, Karp RB. Prosthetic mitral valve replacement late complications after native valve preservation. Ann Thorac Surg ) Prabhakar G, Kumar N, Hatle L, al-halees Z, Duran CM. Accelerated failure of bioprosthesis by entrapment in chordal-sparing mitral valve replacement. J Thorac Cardiovasc Surg ) Edmunds LH, Clark RE, Cohn LH, Miller DC, Weisel RD. Guideline for reporting morbidity and mortality after cardiac valvular operations. Ann Thorac Surg ) Grunkemeier GL, Starr A. Actuarial analysis of surgical results rationale and method. Ann Thorac Surg ) Anderson RP, Bonchek LI, Grunkemeier GL, Lambert LE, Starr A. The analysis and presentation of surgical results by actuarial methods. J Surg Res ) Morgan RJ, Davis JT, Fraker TD. Current status of valve pro-sthesis. Surg Clin North Am ) Akins CW. Results with mechanical cardiac valvular prostheses. Ann Thorac Surg ) Minardi G, di Segni M, Boccardi L, Ferrari O, Giovannini E. Doppler echocardiography in assessing mechanical and biologic heart valve prosthesis. G Ital Cardiol ) de Wall RA, Pelletier LC, Panebianco A, Hicks G, Schuster B, Bonan R, Martineau JP, Yip L. Five year clinical experience with the ominscience cardiac valve. Ann Thorac Surg ) Fananapazir L, Clarke DB, Dark JF, Lawson RA, Moussalli H. Results of replacement with the omniscience prosthesis. J Thorac Cardiovasc Surg ) Rabago G, Martinell J, Fraile J, Andrade IG, Montenegro R. Results and complication with the omniscience prosthesis. J Thorac Cardiovasc Surg ) Cortina JM, Martinell J, Artiz V, Fraile J, Rabago G. Comparative clinical results with omniscience STM1, medtronic-hall, and bjork-shilley convexo-concave 7 degrees prosthesis in mitral valve replacement. J Thorac Cardiovasc Surg ) Damle A, Coles J, Teijeira J, Pelletier C, Callaghan J. A six-year study of the omniscience valve in four Canadian centers. Ann Thorac Surg ) Evangelista Masip A, Bruguera Cortada J, Serrat Serradell R, Robles Castro A. Echocardiographic findings in pannus ingrowth on an omniscience mitral prostheisis. Clin Cardiol ) Carrier M, Martineau JP, Bonan R, Pelletier LC. Clinical and hemodynamic assessment of the omniscience prosthetic heart valve. J Thorac Cardiovasc Surg ) Cordoba M, Almeida P, Martinez P, Maravi C, Ramirez JA, Rabago G. Invasive assessment of mitral valve prosthesis. In Rabago G, Cooley DA, editor. Heart valve replacement and future trends in cardiac surgery. 1st ed. New York Futura p ) Misawa Y, Hasegawa T, Kato M, Ide H. Clinical experience with omniscience and omnicarbon prostheitic heart valves. Nippon Kyobu Geka Gakkai Zasshi ) Akalin H, Corapcioglu ET, Ozyurda U, Ucanok K, Uysalel A, Kaya B, Eren NT, Erol C. Clinical evaluation of the Omniscience cardiac valve prosthesis. J Thorac Cardiovasc Surg ) Teijeira FJ. Long-term experience with the omniscience cardiac valve. J Heart Valve Dis ) Arom KV, Nicoloff DM, Kersten TE, Northrup WF 3rd, Linsay WG, Emery RW. Ten years experience with the st. jude medical valve prosthesis. Ann Thorac Surg ) Fernandez J, Laub GW, Adkins MS, Anderson WA, Chen C, Bailey BN, Nealon LM, McGrath LB. Early and latephase events after valve replacement with the st. jude medical prosthesis in 12 patients. J Thorac Cardiovasc Surg

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1.. Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University :