Original Articles Korean Circulation J 22;327:588-595 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 5.8.9 standard error, SE years with a mean follow-up interval of 8.5.7 SE months. The 311 patients received the following type s of valvemitral, aortic, both or tricuspid valve, in 166 47.9, 99 32., 44 19.5 and 2.6 of cases, respectively. The cumulative follow up was 1143.4 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 72.58.2 SE. Freedom from pannus formation, paravalvular leak, or thromboembolism plus anticoagulant related bleeding were 83.13.5 MVR/AVR 92.74.7/73.42.8, 95.22.1 MVR/AVR 96.84.2/93.63.2, and 96.12.5 MVR/AVR 95.65.6/96.74.7 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;327:588-595 KEY WORDSHeart valve prosthesisprosthesis failurefollow-up studies. 서 - 론 - - - 588
대상 대상및방법 - 수술방법 Table 1. Demographic and clinical characteristics Sex Characteristic MVR n166 AVR n99 Male 92 55 Female 74 44 Age mean, year 42.47.6 48.412.5 NYHA class mean 3.2.7 3.5.5 Valve size mm 23.63.1 27.63.4 Rheumatic 125 75.3% 74 75.2% Previous valve prosthesis failure 12 7.2% 8 8.% MVRmitral valve replacement, AVRaortic valve replacement, NYHANew York heart association 추적관찰및항응고제투여 - - 통계방법 - - 결과 사망및재수술환자군 589
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 6 5 11 Pannus 7 8 15 Valve thrombus 4 4 Endocarditis 1 1 Hemolysis 1 1 2 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;327:588-595
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% 58.13.7 56.2414.2 58.313.5* Valve angle Aortic valve pressure gradient mmhg of AVR patients Peak 68.934.3 26.75.6 69.53.2* Mean 48.12.6 16.23.2 42.115.5* Mitral valve pressure gradient mmhg of MVR patients Mean 1.44.6 3.42.6 32.29.6* Mitral valve area cm 2 of MVR patient 4.13.2* 2D planimetry 1..7 1.7.5 Pressure half time 1.1.3 1.8.6 1.5.4* 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 14 1.9.2 95.65.6 6 1.4.3 96.74.2 Prosthetic endocarditis 3.4.1 98.93.2 1.2. 99.1.9 Pannus formation 12 1.7.4 92.74.7 26 6.1.9 73.42.8 Paravalvular leak 9 1.3.3 96.84.2 6 1.4.5 93.63.2 Hemolysis 2.3.1 98.93.4 2.5.2 91.55.6 Total 4 5.6.3 76.27.2 41 9.6.5 69.72.6 Redo-operation 15 2.1.6 9.82.7 12 3.8.8 82.62.5 %/pt-yrse, %SE, MVRmitral valve replacement, AVRaortic valve replacement 591
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, 1996 9 765 1.3 4.3 177 57 Medtronic hall 3. 1.6 96.22 1.1 99.11 2.5 726 Arom, 1989 22 238 1. 3.8 698 64 St. Jude 3.6 Fernandez, 1994 23 1676 1. 3.8 698 58 St. Jude 2.1.6.4.1 Teijeira, 1997 21 68 13. 8.3 85 58 Omniscience 2.2 795 1.4 962.4 953.1 991 2.8 716 Kim, 2 present study 424 8. 5.9 99 48 Omniscience 1.4 964.5 915.2 992 1.4 933 6.1 733 1.3 947 3.8 832 MVR Akins, 1996 9 481 1.3 4.6 16 62 Medtronic hall 4. 1 1. 885 2.1 826 1 4.4 637 Arom, 1989 22 1471 1. 3.8 464 6 St. Jude.1 5.6 Fernandez, 1994 23 135 1. 2.9 49 58 St. Jude 4.7.5 1.1.1 Teijeira, 1997 21 716 12.5 7.7 13 56 Omniscience 2.1 835 1.1 991.3 982.3 973 3.2 675 Kim, 2 present study 719 8. 4.9 166 42 Omniscience 1.9 955.3 993.4 993 1.3 974 1.7 925.4 995 2.1 913 Our follow-up duration was eight years. no data from authors, TEthromboembolism including valve thrombosis, ARHanticoagulant related hemorrhage 592 Korean Circulation J 22;327:588-595
심초음파소견 - 고찰 - - - - - - - 593
- - - 594 - 요약 배경및목적 : 방법 : 결과 : Korean Circulation J 22;327:588-595
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