Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Eur J Cardiothorac Surg. 2010 Jan;37(1):154-8. doi: 10.1016/j.ejcts.2009.06.046. Epub 2009 Aug 20.
Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with recurrent arterial and venous thrombotic events. Heart valve abnormalities are commonly found in patients with APS.
From March 1998 to March 2007, nine patients with APS underwent heart valve surgery using cardiopulmonary bypass. We retrospectively reviewed their clinical data, operative and postoperative courses and the long-term results.
The mean age was 43.6+/-10.4 years, six were female and three male. Four patients underwent mitral valve replacement, three went through aortic valve replacement, one underwent combined mitral-aortic valve replacement and another aortic valve plasty. The syndrome was primary in seven patients and associated with systemic lupus erythematosus (SLE) in two. Follow-up was 8 days to 8 years (median 66 months). Two patients died in the early postoperative period: both due to an acute cerebrovascular accident. Four patients presented an uneventful late postoperative course. One patient experienced an ischaemic stroke 5 years after mitral valve replacement (MVR) and developed refractory congestive heart failure requiring heart transplantation three years postoperatively.
Heart valve surgery in patients with antiphospholipid syndrome may carry considerable early and late mortality and morbidity. Thrombo-embolic complications are the most common complications. Mechanical prostheses have been used at our Institution in the previous years; however, today, after reviewing our historical results, we reconsider our general strategy and believe that tissue heart valve prostheses are the possible ideal substitutes, minimising the risks of morbidity and mortality due to the hypercoagulable state of APS.
抗磷脂综合征（APS）是一种罕见的与复发性动静脉血栓事件相关的凝血障碍。心脏瓣膜异常在 APS 患者中很常见。
1998 年 3 月至 2007 年 3 月，9 例 APS 患者接受体外循环下心瓣膜手术。我们回顾性分析了他们的临床资料、手术和术后过程及长期结果。
平均年龄 43.6±10.4 岁，女性 6 例，男性 3 例。4 例患者行二尖瓣置换术，3 例行主动脉瓣置换术，1 例同时行二尖瓣-主动脉瓣置换术，1 例行主动脉瓣成形术。7 例为原发性 APS，2 例与系统性红斑狼疮（SLE）相关。随访时间 8 天至 8 年（中位数 66 个月）。2 例患者术后早期死亡：均因急性脑血管意外。4 例患者术后晚期无并发症。1 例患者在二尖瓣置换术后 5 年发生缺血性脑卒中，术后 3 年出现难治性充血性心力衰竭，需要心脏移植。
抗磷脂综合征患者行心瓣膜手术可导致较高的早期和晚期死亡率和发病率。血栓栓塞并发症是最常见的并发症。本机构在过去几年中使用了机械假体；然而，在回顾我们的历史结果后，我们重新考虑了我们的总体策略，并认为组织心脏瓣膜假体是可能的理想替代品，可以最大限度地减少 APS 高凝状态导致的发病率和死亡率风险。
