Mechanical Pulmonary Valve Replacement.
Mechanical Pulmonary Valve Replacement.
复制标题
机械肺动脉瓣置换术。
DOI：
10.1053/j.pcsu.2015.12.003
复制
发表时间：
2016
期刊：
影响因子：
--
通讯作者：
J. Dearani
中科院分区：
文献类型：
--
作者：
J. Stulak;B. Mora;Sameh M. Said;H. Schaff;J. Dearani
虽然每年进行的大多数瓣膜手术都是针对主动脉瓣或二尖瓣的病变，但肺瓣膜置换术（PVR）的频率正在增加，因为大多数先天性心脏病患者都能活到成年。绝大多数患者，特别是需要PVR的儿童，因为相对较好的耐久性和不需要抗凝而获得组织瓣膜。因为对大多数患者来说，需要重复手术是不可避免的，而且患有先天性心脏病的成人人数不断增加，因此机械肺假体可能是合适的情况越来越多。大多数考虑机械PVR的患者有先天性诊断，需要多瓣膜手术，生活质量和需要重复手术是主要问题。机械阀门很耐用，但需要抗凝，这有其固有的风险。关于机械PVR的晚期结果，有相互矛盾的报道。很少有报道表明，在肺动脉位置，双小瓣膜比单瓣瓣膜有更高的并发症风险；然而，这些患者中的大多数没有使用华法林抗凝，而只是简单地维持阿司匹林。越来越多的文献表明，当适当的抗凝和监测应用时，血栓形成或肺假体功能障碍的发生率较低。
Although most valve operations performed annually address lesions of the aortic or mitral valves, the frequency of pulmonary valve replacement (PVR) is increasing because most patients with congenital heart disease are surviving into the adult years. The vast majority of patients, especially children that require PVR, obtain a tissue valve because of the relative good durability and the lack of a need for anticoagulation. Because the need for repeat operation is inevitable for most patients, and the population of adults with congenital heart disease continues to grow, there are increasing situations in which a mechanical pulmonary prosthesis may be appropriate. Most patients being considered for mechanical PVR have a congenital diagnosis and require multi-valve procedures, and quality of life and need for repeat operation(s) are major issues. Mechanical valves are durable but require anticoagulation, which carries its own inherent set of risks. There are conflicting reports regarding the late outcome of mechanical PVR. There are few reports that indicate that, in the pulmonary position, bileaflet valves are at higher risk for complications compared with monodisc valves; however, the majority of these patients were not anticoagulated with warfarin, but simply maintained on aspirin. There is a growing body of literature documenting low rates of thrombosis or pulmonary prosthesis dysfunction when proper anticoagulation and monitoring are applied.