Misawa Yoshio
Division of Cardiovascular Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Surg Today. 2015 Oct;45(10):1205-9. doi: 10.1007/s00595-014-1104-0. Epub 2014 Dec 18.
The number of heart valve surgeries is increasing, and 19,164 patients underwent heart valve surgery in Japan in 2011. The early mortality rate has remained stable for more than 10 years. Many patients now survive for many years, with a reported 10-year survival rate of at least 60 %. However, unfavorable complications can occur after valve surgery. Valve-related complications include thromboembolisms, bleeding complications and prosthetic valve endocarditis, followed by structural and nonstructural prosthetic valve dysfunctions. Our review of studies published after 2000 revealed that the rate of all valve-related complications was 0.7-3.5 % per patient-year. Thromboembolisms occur at a rate of approximately 1 % per patient-year, and bleeding complications occur at almost 0.5 % per patient-year. Thromboembolic and hemorrhagic events related to anticoagulant therapy should be considered during life-long follow-up. The occurrence rate of endocarditis reaches 0.5 % per patient-year, with a poor postoperative survival. Structural dysfunctions have been largely overcome, and the nonstructural dysfunction rate is 0.4-1.2 % per patient-year. The nonstructural dysfunctions induced by paravalvular leaks and pannus ingrowth are also issues that need to be resolved.
心脏瓣膜手术的数量正在增加，2011年日本有19164名患者接受了心脏瓣膜手术。早期死亡率在10多年来一直保持稳定。现在许多患者能存活多年，据报道10年生存率至少为60%。然而，瓣膜手术后可能会出现不良并发症。与瓣膜相关的并发症包括血栓栓塞、出血并发症和人工瓣膜心内膜炎，其次是人工瓣膜的结构性和非结构性功能障碍。我们对2000年后发表的研究进行的综述显示，所有与瓣膜相关并发症的发生率为每年每患者0.7%-3.5%。血栓栓塞的发生率约为每年每患者1%，出血并发症的发生率几乎为每年每患者0.5%。在终身随访期间应考虑与抗凝治疗相关的血栓栓塞和出血事件。心内膜炎的发生率达到每年每患者0.5%，术后生存率较低。结构性功能障碍已在很大程度上得到克服，非结构性功能障碍的发生率为每年每患者0.4%-1.2%。由瓣周漏和血管翳长入引起的非结构性功能障碍也是需要解决的问题。
