Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, Keck School of Medicine at University of Southern California, Los Angeles, California 90033, USA.
J Am Coll Cardiol. 2010 Jun 1;55(22):2413-26. doi: 10.1016/j.jacc.2009.10.085.
In the last 7 years, more data have reconfirmed that patients' comorbid conditions are very important factors determining patient outcomes. Prosthetic heart valves (PHVs) that require aortic root replacement in the absence of aortic root disease are associated with poorer outcomes. For the vast majority of patients, the choice of PHV is between a mechanical valve and a stented bioprosthesis. The choice is largely dependent upon the age of the patient at the time of PHV implantation and on which complication the patient wants to avoid: specifically, anticoagulation therapy and its complications with the mechanical valve, and structural valve deterioration with a bioprosthesis. Data on the pros and cons of the choices and exceptions to the rules are discussed, and a new algorithm is developed.
在过去的 7 年中，更多的数据再次证实，患者的合并症是决定患者预后的非常重要因素。在不存在主动脉根部疾病的情况下需要更换主动脉根部的人工心脏瓣膜（PHV）与较差的预后相关。对于绝大多数患者而言，PHV 的选择在机械瓣和带支架的生物瓣之间。选择主要取决于 PHV 植入时患者的年龄，以及患者希望避免哪种并发症：具体而言，是机械瓣的抗凝治疗及其并发症，还是生物瓣的结构性瓣膜退化。讨论了这些选择的优缺点以及例外情况，并制定了新的算法。
