Prosthetic valve thrombosis:: Twenty-year experience at the Montreal Heart Institute
Prosthetic valve thrombosis:: Twenty-year experience at the Montreal Heart Institute
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DOI：
10.1016/j.jtcvs.2003.12.013
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发表时间：
2004-05-01
影响因子：
6
通讯作者：
Carrier, M
中科院分区：
文献类型：
--
作者：
Dürrleman, N;Pellerin, M;Carrier, M
背景：人工瓣膜血栓形成是一种危及生命的并发症。我们回顾了这种罕见并发症的发生率、危险因素和治疗策略。方法：从 1981 年 2 月到 2001 年 1 月，蒙特利尔心脏研究所对 4924 名患者进行了 5430 例瓣膜手术。在该队列中，有 39 名患者出现人工瓣膜血栓，并从我们的前瞻性瓣膜临床数据库中获得了完整的随访数据。结果：在该系列中，82% 的患者为女性，平均年龄为 58 +/- 11 岁。 75% 的病例潜在病理涉及二尖瓣。大多数人工瓣膜血栓发生在机械假体上（95%）。从第一次瓣膜置换到人工瓣膜血栓形成的时间间隔为 39 +/- 42 个月。最常见的临床表现是严重充血性心力衰竭（44%）。在人工瓣膜血栓形成方面，54% 的患者国际标准化比率低于 2.5，26% 的患者抗凝管理不充分，26% 的患者依从性差。 82% 的患者接受了外科手术，其中 47% 的患者接受了血栓切除术，47% 的患者接受了二尖瓣置换术，6% 的患者接受了主动脉瓣置换术。人工瓣膜血栓形成后 30 天手术死亡率和院内总死亡率分别为 25% 和 41%。人工瓣膜血栓后10年精算生存率为46%+/-10%。结论：抗凝水平不足是人工瓣膜血栓发病的最重要因素。尽管进行了手术治疗，总体死亡率仍然很高。这项研究强调了对人工瓣膜患者抗凝治疗进行细致监测的重要性。
Background: Prosthetic valve thrombosis is a life-threatening complication. We reviewed the incidence, risk factors, and treatment strategies of this rare complication.Methods: From February 1981 through January 2001, 5430 valve operations were performed in 4924 patients at the Montreal Heart Institute. Of this cohort, 39 patients presented with prosthetic valve thrombosis and had complete follow-up data obtained from our prospective valve clinic database.Results: In this series 82% of patients were women, and the mean age was 58 +/- 11 years. The underlying pathology involved the mitral valve in 75% of cases. Most prosthetic valve thromboses occurred with mechanical prostheses (95%). The time interval from first valve replacement to prosthetic valve thrombosis was 39 +/- 42 months. The most frequent clinical presentation was severe congestive heart failure (44%). On prosthetic valve thrombosis presentation, the international normalized ratio was less than 2.5 in 54%, with inadequate anticoagulation management in 26% and poor compliance in 26%. Eighty-two percent of patients underwent a surgical procedure, consisting of thrombectomy in 47%, mitral valve replacement in 47%, and aortic valve replacement in 6% of patients. The 30-day operative mortality and total in-hospital mortality after prosthetic valve thrombosis were 25% and 41%, respectively. The 10-year actuarial survival after prosthetic valve thrombosis was 46% +/- 10%.Conclusion: Inadequate level of anticoagulation is the most important factor involved in the pathogenesis of prosthetic valve thrombosis. The overall mortality rate despite surgical treatment remains high. This study underscores the importance of meticulous surveillance of anticoagulation therapy in patients with prosthetic valves.