Mve Mvondo Charles, Pugliese Marta, Ambassa Jean Claude, Giamberti Alessandro, Bovio Emanuele, Dailor Ellen
Division of Cardiac Surgery, Shisong Hospital, Shisong, Bui, Cameroon.
Division of Cardiac Surgery, Fondazione PTV Policlinico Tor Vergata, Roma, Lazio, Italy.
Thorac Cardiovasc Surg. 2020 Mar;68(2):99-106. doi: 10.1055/s-0038-1666873. Epub 2018 Jul 18.
The management of patients with mechanical heart valves remains a major concern in populations with limited resources and medical facilities. This study reports the clinical outcomes of patients who underwent mechanical valve implantation in a sub-Saharan center over an 8-year period.
A total of 291 mechanical valves were implanted in 233 patients in our institution between February 2008 and June 2016. A total of 117 patients underwent mitral valve replacement (MVR, 50.2%), 57 had aortic valve replacement (AVR, 24.4%), and 59 underwent both AVR and MVR (double valve replacement [DVR], 25.7%). The mean age at surgery was 27.6 ± 13.4 years (range, 7-62 years). Rheumatic etiology was found in 80.6% of the patients. Hospital mortality, late deaths, and valve-related events were reviewed at follow-up (839 patient-years, range: 1-9.4 years, complete in 93%).
The 30-day mortality was 4.7% (11/233). The overall survival at 1 and 6 years for the whole cohort was 88.8 ± 2.1% and 78.7 ± 3.3%, respectively. The 6-year survival for AVR, MVR, and DVR was 89.3 ± 4.8%, 73.2 ± 5.4%, and 79.3 ± 5.8%, respectively ( = 0.15). The freedom from neurologic events and anticoagulation-related bleeding at 6 years was 93.1 ± 2.1% and 78.9 ± 3.7%, respectively. No patient had reoperation at follow-up. No case of prosthetic valve thrombosis was identified. Eight full-term pregnancies were reported.
This preliminary experience reports acceptable midterm results after mechanical heart valve implantation in our region. Both accurate surgical evaluation and strategies, either financial or social, facilitating patient's education and medical assistance are crucial to ensure good results. Long-term follow-up and further studies comparing current nonthrombogenic options are warranted to draw reliable conclusions.
在资源和医疗设施有限的人群中，机械心脏瓣膜患者的管理仍然是一个主要问题。本研究报告了撒哈拉以南地区一个中心在8年期间接受机械瓣膜植入患者的临床结果。
2008年2月至2016年6月期间，我们机构共为233例患者植入了291个机械瓣膜。共有117例患者接受二尖瓣置换术（MVR，50.2%），57例接受主动脉瓣置换术（AVR，24.4%），59例接受AVR和MVR（双瓣膜置换术[DVR]，25.7%）。手术时的平均年龄为27.6±13.4岁（范围7 - 62岁）。80.6%的患者病因是风湿性的。随访时评估了医院死亡率、晚期死亡和瓣膜相关事件（839患者年，范围：1 - 9.4年，93%完成随访）。
30天死亡率为4.7%（11/233）。整个队列1年和6年的总生存率分别为88.8±2.1%和78.7±3.3%。AVR、MVR和DVR的6年生存率分别为89.3±4.8%、73.2±5.4%和79.3±5.8%（P = 0.15）。6年时无神经系统事件和抗凝相关出血的发生率分别为93.1±2.1%和78.9±3.7%。随访期间无患者再次手术。未发现人工瓣膜血栓形成病例。报告了8例足月妊娠。
这项初步经验报告了我们地区机械心脏瓣膜植入术后可接受的中期结果。准确的手术评估以及促进患者教育和医疗援助的财务或社会策略对于确保良好结果至关重要。需要长期随访并进一步研究比较当前的非血栓形成选择，以得出可靠结论。
