Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America.
Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN 55905, United States of America.
Int J Cardiol. 2019 Sep 15;291:45-49. doi: 10.1016/j.ijcard.2019.02.028. Epub 2019 Feb 16.
There are limited data about the outcomes mechanical prostheses in adults with tetralogy of Fallot (TOF). The purpose of the study was to describe the incidence of mechanical valve related adverse events (MVRAE), reoperation and all-cause mortality in TOF patients with mechanical valve prostheses.
We reviewed the MACHD (Mayo Adult Congenital Heart Disease) database and identified all adult TOF patients with mechanical valve prostheses, 1990-2017. MVRAE was defined as valve thrombosis, endocarditis, embolic stroke or major bleeding complications.
A total of 44 prostheses were implanted in 29 patients (age 44 ± 13 years; men 18 [62%]), and 10 (36%) patients received multiple mechanical prostheses. The median number of prior sternotomies was 3 (range 2-7). Target intentional normalized ratio (INR) was 2.0-3.0 for patients with isolated mechanical aortic prostheses (n = 12, 41%), 2.5-4.0 for mechanical prostheses in non-aortic positions. There were no surgical deaths, and 10 MVRAE (endocarditis [n = 4], major bleeding complications [n = 5] and valve thrombosis [n = 1]) occurred in 7 (24%) patients during a median follow-up of 11 (5 18) years. The 10-year survival and freedom from reoperation were 87% and 95% respectively.
Surgical mortality and valve thrombosis for mechanical valve prostheses are low presumably due to appropriate patient selection and meticulous anticoagulation. Endocarditis and bleeding complications are major concerns. Further studies are required to determine the appropriate target INR that provides the optimal balance between preventing valve thrombosis and avoiding major bleeding complications mechanical valve prostheses in different positions.
关于法洛四联症（TOF）成人使用机械瓣膜的结果数据有限。本研究的目的是描述 TOF 患者使用机械瓣膜的机械瓣膜相关不良事件（MVRAE）、再次手术和全因死亡率的发生率。
我们回顾了 MACHD（Mayo 成人先天性心脏病）数据库，确定了 1990 年至 2017 年期间所有使用机械瓣膜假体的成年 TOF 患者。MVRAE 定义为瓣膜血栓形成、心内膜炎、栓塞性中风或大出血并发症。
共植入 44 个假体，29 例患者（年龄 44±13 岁；男性 18 例[62%]），10 例（36%）患者接受了多个机械假体。既往正中胸骨切开术的中位数为 3 次（范围 2-7 次）。孤立性机械主动脉瓣假体患者的目标理想国际标准化比值（INR）为 2.0-3.0（n=12，41%），非主动脉位置的机械假体为 2.5-4.0。无手术死亡，10 例 MVRAE（心内膜炎[n=4]、大出血并发症[n=5]和瓣膜血栓形成[n=1]）发生在 7 例（24%）患者中，中位随访 11 年（5 至 18 年）。10 年生存率和免于再次手术率分别为 87%和 95%。
机械瓣膜假体的手术死亡率和瓣膜血栓形成率较低，可能是由于适当的患者选择和细致的抗凝治疗。心内膜炎和出血并发症是主要关注点。需要进一步研究确定不同位置的机械瓣膜提供最佳的瓣膜血栓形成和避免大出血并发症之间平衡的适当目标 INR。
