Sachdev Sarina, Bardia Nikky, Nguyen Landai, Omar Bassam
University of South Alabama, Mobile, AL 36617, USA.
Cardiol Res. 2018 Dec;9(6):335-342. doi: 10.14740/cr789. Epub 2018 Dec 7.
Degenerative valve disease is on the rise with greater than 100,000 valve operations performed in the US alone per year. The majority of those procedures employ tissue bioprostheses to avoid the attendant risk of anticoagulation, especially in the elderly. Though traditionally this approach has been considered a superior option to avoid anticoagulation, more recent analyses have demonstrated a significant incidence of previously unrecognized thrombosis associated with bioprosthetic valves, especially with the more recent advent of the transcatheter aortic valve replacement implantations. Bioprosthetic valve thrombosis is a major cause of either acute or indolent bioprosthetic valve degeneration, and often has an elusive presentation causing delayed recognition and treatment. The literature has extensively addressed the risks and benefits of anticoagulation following bioprosthetic valve replacement to prevent bioprosthetic valve thrombosis (BPVT), without conclusive evidence-based recommendations. The duration of anticoagulation following an episode of BPVT is unclear, and lifelong anticoagulation has been suggested. The increasing use of transcatheter aortic valve replacement as an alternative to surgical aortic valve replacement in various risk groups has introduced new challenges with regards to valve thrombosis, which have been poorly studied with regards to optimal treatment and prevention. The increasing use of valve-in-valve procedures is expected to bring on further uncharted challenges.
退行性瓣膜病的发病率正在上升，仅在美国每年就有超过10万例瓣膜手术。这些手术中的大多数采用组织生物瓣膜以避免抗凝带来的风险，尤其是在老年人中。虽然传统上这种方法被认为是避免抗凝的更好选择，但最近的分析表明，与生物瓣膜相关的先前未被认识到的血栓形成发生率很高，特别是随着经导管主动脉瓣置换植入术的出现。生物瓣膜血栓形成是急性或隐匿性生物瓣膜退变的主要原因，并且通常表现难以捉摸，导致诊断和治疗延迟。文献广泛讨论了生物瓣膜置换术后抗凝预防生物瓣膜血栓形成（BPVT）的风险和益处，但没有基于确凿证据的建议。BPVT发作后的抗凝持续时间尚不清楚，有人建议终身抗凝。在各种风险人群中，越来越多地使用经导管主动脉瓣置换术替代外科主动脉瓣置换术，这在瓣膜血栓形成方面带来了新的挑战，而关于最佳治疗和预防方面的研究很少。预计越来越多地使用瓣中瓣手术将带来更多未知的挑战。
