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本文引用的文献

1
Thrombotic Risk and Antithrombotic Strategies After Transcatheter Mitral Valve Replacement.经导管二尖瓣置换术后的血栓风险和抗栓策略。
JACC Cardiovasc Interv. 2019 Dec 9;12(23):2388-2401. doi: 10.1016/j.jcin.2019.07.055.
2
Early and Late Leaflet Thrombosis After Transcatheter Aortic Valve Replacement.经导管主动脉瓣置换术后早期和晚期瓣叶血栓形成。
Circ Cardiovasc Interv. 2019 Feb;12(2):e007349. doi: 10.1161/CIRCINTERVENTIONS.118.007349.
3
Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification.经导管二尖瓣置换术治疗退行性生物瓣、瓣环成形术失败和二尖瓣环钙化的结果。
Eur Heart J. 2019 Feb 1;40(5):441-451. doi: 10.1093/eurheartj/ehy590.
4
Clinical and haemodynamic outcomes of balloon-expandable transcatheter mitral valve implantation: a 7-year experience.经皮球囊扩张式经导管二尖瓣植入术的临床和血液动力学结局：7 年经验。
Eur Heart J. 2018 Jul 21;39(28):2679-2689. doi: 10.1093/eurheartj/ehy271.
5
Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement.经导管主动脉瓣置换术后抗凝治疗对瓣膜血液动力学恶化的影响。
Heart. 2018 May;104(10):814-820. doi: 10.1136/heartjnl-2017-312514. Epub 2018 Feb 13.
6
Transseptal Transcatheter Mitral Valve Replacement Using Balloon-Expandable Transcatheter Heart Valves: A Step-by-Step Approach.经皮球囊扩张式经导管二尖瓣置换术：一种分步方法。
JACC Cardiovasc Interv. 2017 Oct 9;10(19):1905-1919. doi: 10.1016/j.jcin.2017.06.069.
7
Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves.生物瓣主动脉瓣活动受影响的亚临床瓣叶血栓形成的自然史。
Eur Heart J. 2017 Jul 21;38(28):2201-2207. doi: 10.1093/eurheartj/ehx369.
8
Transcatheter Mitral Valve Replacement: Insights From Early Clinical Experience and Future Challenges.经导管二尖瓣置换术：早期临床经验和未来挑战的启示。
J Am Coll Cardiol. 2017 May 2;69(17):2175-2192. doi: 10.1016/j.jacc.2017.02.045.
9
Transcatheter aortic valve thrombosis: the relation between hypo-attenuated leaflet thickening, abnormal valve haemodynamics, and stroke.经导管主动脉瓣血栓形成：瓣叶变薄低衰减、瓣膜异常血流动力学与卒中的关系。
Eur Heart J. 2017 Apr 21;38(16):1207-1217. doi: 10.1093/eurheartj/ehx031.
10
Transcatheter Mitral Valve Replacement for Patients With Symptomatic Mitral Regurgitation: A Global Feasibility Trial.经导管二尖瓣置换术治疗有症状二尖瓣反流患者的全球可行性试验。
J Am Coll Cardiol. 2017 Jan 31;69(4):381-391. doi: 10.1016/j.jacc.2016.10.068. Epub 2016 Dec 28.

经皮球囊扩张二尖瓣生物瓣置换术后血栓形成的预测因素及临床影响。

Predictors and clinical impact of thrombosis after transcatheter mitral valve implantation using balloon-expandable bioprostheses.

机构信息

Department of Cardiology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.

出版信息

EuroIntervention. 2021 Apr 20;16(17):1455-1462. doi: 10.4244/EIJ-D-20-00991.

DOI:10.4244/EIJ-D-20-00991
PMID:33226001
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9724835/
Abstract

AIMS

The aim of this study was to report the predictors and clinical impact of transcatheter heart valve (THV) thrombosis in patients undergoing transcatheter mitral valve implantation (TMVI).

METHODS AND RESULTS

We included 130 patients who consecutively underwent TMVI. Transoesophageal echocardiography (TOE) and/or computed tomography (CT) were performed in 91.7% of patients at discharge, in 73.3% at three months and in 72% beyond three months. THV thrombosis was defined as the presence of at least one thickened leaflet with restricted motion confirmed by TOE or contrast CT and classified as immediate, early, or late according to the timing of diagnosis. THV thrombosis was observed in 16 (12.3%) patients: immediate in 43.7%, early in 37.5% and late in 18.8%. Most of these thromboses were subclinical (93.7%) and non-obstructive (87.5%). No thromboembolic event occurred. After optimisation of antithrombotic treatment, THV thromboses resolved in all but one patient. Predictors were shock for immediate (p<0.001), male sex for early (p=0.045) and absence of anticoagulation for both early (p=0.018) and late (p=0.023) THV thromboses.

CONCLUSIONS

THV thrombosis is frequent after TMVI, occurs mainly within the first three months, is mostly subclinical and resolves after optimisation of antithrombotic treatment. An anticoagulation therapy for at least three months after the procedure is mandatory.

摘要

目的

本研究旨在报告行经导管二尖瓣置换术（TMVI）患者发生经导管心脏瓣膜（THV）血栓的预测因素和临床影响。

方法和结果

我们纳入了 130 例连续接受 TMVI 的患者。91.7%的患者在出院时、73.3%的患者在三个月时和 72%的患者在三个月后进行经食管超声心动图（TOE）和/或计算机断层扫描（CT）。THV 血栓形成定义为至少有一个增厚的瓣叶，运动受限，通过 TOE 或对比 CT 证实，并根据诊断时间分为即刻、早期或晚期。16 例（12.3%）患者发生 THV 血栓形成：即刻占 43.7%，早期占 37.5%，晚期占 18.8%。这些血栓大多数为亚临床（93.7%）和非阻塞性（87.5%）。没有发生血栓栓塞事件。在优化抗血栓治疗后，除 1 例患者外，所有患者的 THV 血栓均得到解决。即刻血栓形成的预测因素为休克（p<0.001），早期血栓形成的预测因素为男性（p=0.045），早期和晚期血栓形成均无抗凝治疗（p=0.018 和 p=0.023）。

结论

TMVI 后 THV 血栓形成较为常见，主要发生在最初的三个月内，大多数为亚临床，经优化抗血栓治疗后可得到解决。术后至少进行三个月的抗凝治疗是强制性的。