이종심조직판막기능부전에 대한 외과적 요법 = Surgical experiences of tissue valve failure

다국어 초록 (Multilingual Abstract)

Results of reoperation for tissue valve failure were presented with review of current knowledge. Through January 1986, 19 patients required reoperation: 18 had undergone mitral, 2 aortic, and 1 tricuspid valve. Primary tissue failure was the main cause of tissue valve failure: it occurred in 18 valves [15 mitral, 2 aortic, and 1 tricuspid] at a mean postoperative interval of 54-25 months [range 29-120]. During the same period, 2 patients required reoperation for prosthetic valve endocarditis, 1 for paravalvular leakage. The types of valves failed were 12 lonescu-Shiley valves, 5 Hancock valves, and 1 Carpentier-Edwards valve. All 6 patients younger than 15 years of age at first operation had been implanted with lonescu-Shiley valves and failed after a mean interval of 35 months. In contrast, 11 patients older than 15 years had been implanted with 5 Hancock, 6 lonescu-Shiley, and 1 Carpentier-Edwards valve initially, and eventually failed after mean intervals of 81, 53, 47 months each other. The kinds of valves used at reoperation were 8 lonescu-Shiley, 4 Bjork-Shiley, and 6 St. Jude Medical valves for primary tissue failure cases and 3 lonescu-Shiley valves for the other 3 cases. Overall mortality at reoperation was 10%: 5.6% for primary tissue failure, 50% for prosthetic valve endocarditis. In 15 cases [all mitral] primary tissue failure were caused by calcification associated with or without leaflet destruction or fibrous ingrowth, and in 2 cases [all aortic] caused by cusp perforation and tearing without any evidence of calcification. In conclusion: 1 primary tissue failure is the main cause of reoperation in patients with tissue valve failure; 2. the majority of the failed valves is in mitral position; 3. leaflet calcification is the leading pathology of primary tissue failure; 4, reoperation for tissue valve failure may be a major concern, although the mortality is low; 5. the limited durability of tissue valve suggests its use be restricted to selected cases.