65岁及以下和65岁及以上患者主动脉瓣置换用双叶机械瓣膜：主要血栓栓塞和出血并发症

Bileaflet mechanical prostheses for aortic valve replacement in patients younger than 65 years and 65 years of age or older: major thromboembolic and hemorrhagic complications.

作者信息

Jamieson W R, Miyagishima R T, Grunkemeier G L, Germann E, Henderson C, Lichtenstein S V, Ling H, Munro A I

机构信息

St. Paul's Hospital-Heart Centre, Vancouver General Hospital, University of British Columbia.

出版信息

Can J Surg. 1999 Feb;42(1):27-36.

PMID:10071585

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3788879/

Abstract

OBJECTIVE

To determine major thromboembolic and hemorrhagic complications and predictive risk factors associated with aortic valve replacement (AVR), using bileaflet mechanical prostheses (CarboMedics and St. Jude Medical).

DESIGN

A case series.

SETTING

Cardiac surgical services at the teaching institutions of the University of British Columbia.

PATIENTS AND METHODS

Patients 2 age groups who had undergone AVR between 1989 and 1994 were studied. Group 1 comprised 384 patients younger than 65 years. Group 2 comprised 215 patients 65 years of age and older.

RESULTS

The linearized rates of major thromboembolism (TE) occurring after AVR were 1.54%/patient-year for group 1 and 3.32%/patient-year for group 2; the rates for major TE occurring more than 30 days after AVR were 1.13%/patient-year for group 1 and 1.55%/patient-year for group 2. The crude rates for major TE occurring within 30 days of AVR were 1.04% for group 1 and 3.72% for group 2. The death rate from major TE in group 1 was 0.31%/patient-year and in group 2 was 0.88%/patient-year. Of the major TE events occurring within 30 days, 100% of patients in both age groups were inadequately anticoagulated at the time of the event, and for events occurring more than 30 days after AVR, 45% in group 1 and 57% in group 2 were inadequately anticoagulated (INR less than 2.0). The overall linearized rates of major hemorrhage were 1.54%/patient-year for group 1 and 2.21%/patient-year for group 2. There were no cases of prosthesis thrombosis in either group. The mean (and standard error) overall freedom from major TE for group 1 patients at 5 years was 95.6% (1.4%) and with exclusion of early events was 96.7% (1.3%); for group 2 patients the rates were 90.0% (3.2%) and 93.7% (3.0%), respectively. The mean (and SE) overall freedom from major and fatal TE and hemorrhage for group 1 patients was 90.1% (2.3%) and with exclusion of early events was 91.2% (2.3%); for group 2 patients the rates were 87.9% (3.1%) and 92.5% (2.9%), respectively. The 5-year rate for freedom from valve-related death for group 1 patients was 96.3% (2.1%) and for group 2 patients was 97.2% (1.2%).

CONCLUSION

The thromboembolic and hemorrhagic complications after AVR with bileaflet mechanical prostheses occur more frequently and result in more deaths in patients 65 years of age and older than in patients years younger than 65 years.

摘要

目的

使用双叶机械瓣膜（CarboMedics和圣犹达医疗公司生产）确定与主动脉瓣置换术（AVR）相关的主要血栓栓塞和出血并发症以及预测性风险因素。

设计

病例系列研究。

地点

英属哥伦比亚大学教学机构的心脏外科服务部门。

患者和方法

对1989年至1994年间接受AVR的两个年龄组患者进行研究。第1组包括384名年龄小于65岁的患者。第2组包括215名年龄65岁及以上的患者。

结果

AVR后主要血栓栓塞（TE）的线性化发生率在第1组为1.54%/患者年，在第2组为3.32%/患者年；AVR后30天以上发生主要TE的发生率在第1组为1.13%/患者年，在第2组为1.55%/患者年。AVR后30天内发生主要TE的粗发生率在第1组为1.04%，在第2组为3.72%。第1组主要TE的死亡率为0.31%/患者年，第2组为0.88%/患者年。在30天内发生的主要TE事件中，两个年龄组的患者在事件发生时抗凝均不足，对于AVR后30天以上发生的事件，第1组45%和第2组57%抗凝不足（国际标准化比值[INR]小于2.0）。主要出血的总体线性化发生率在第1组为1.54%/患者年，在第2组为2.21%/患者年。两组均无人工瓣膜血栓形成病例。第1组患者5年时主要TE的总体无事件生存率平均（及标准误）为95.6%（1.4%），排除早期事件后为96.7%（1.3%）；第2组患者的相应发生率分别为90.0%（3.2%）和93.7%（3.0%）。第1组患者主要和致命TE及出血的总体无事件生存率平均（及标准误）为90.1%（2.3%），排除早期事件后为91.2%（2.3%）；第2组患者的相应发生率分别为87.9%（3.1%）和92.5%（2.9%）。第1组患者瓣膜相关死亡的5年无事件生存率为96.3%（2.1%），第2组患者为97.2%（1.2%）。