Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil.
Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.
Arq Bras Cardiol. 2022 Nov;119(5):734-744. doi: 10.36660/abc.20210544.
Valvular heart diseases are highly prevalent in the world, and surgical valve replacement has improved patients' survival.
To describe clinical and laboratory data of patients undergoing mechanical valve replacement, and to determine the incidence of prosthetic valve thrombosis (PVT).
Retrospective cohort study with a follow-up of up to nine years. The study variables were collected from conventional and electronic medical charts. Statistical calculations were performed using the Jamovi software version 1.2.2.; a p<0.05 was considered statistically significant. Kaplan Meier curves were constructed, and Cox regression analysis was performed for analysis of factors related to mortality.
A total of 473 patients were included, mean age of 46.9 ±11.3 years. Rheumatic disease was the most common etiology. In a mean follow-up period of 4.43 years, mortality rate was 16.1%. Patients with aortic prosthesis showed higher survival than patients with double implant (mitral and aortic) (p=0.026). Of the factors adjusted for mortality, only functional class and chronic renal failure showed statistically significant association. The incidence of PVT was 0.24/100 patients/year, and the first event occurred more than 1000 days after the implant. Smoking and pannus formation were significantly associated with PVT. No differences were found in INR variability between patients with and without thrombosis by prosthetic position, but significant differences were found in INR before thrombosis as compared with patients without thrombosis (INR= 2.20 [1.80-2.20] vs. 2.80 [2.20-3.40]; p= 0.040). The incidence of stroke and bleeding was 4.4% and 5.2% respectively.
The study population was young, and rheumatic valve disease was common in this group. The prevalence of PVT was similar to that described in the literature, despite the low income and low educational level of our sample.
瓣膜性心脏病在全球高发，而心脏瓣膜置换术提高了患者的生存率。
描述行机械瓣置换术患者的临床和实验室数据，并确定人造瓣膜血栓形成（PVT）的发生率。
这是一项回顾性队列研究，随访时间长达 9 年。研究变量从常规和电子病历中收集。使用 Jamovi 软件版本 1.2.2 进行统计计算；p<0.05 为统计学显著。构建 Kaplan-Meier 曲线，并进行 Cox 回归分析，以分析与死亡率相关的因素。
共纳入 473 例患者，平均年龄为 46.9 ±11.3 岁。风湿性疾病是最常见的病因。在平均 4.43 年的随访期间，死亡率为 16.1%。主动脉假体患者的生存率高于双植入（二尖瓣和主动脉瓣）患者（p=0.026）。在调整了死亡率的因素中，只有功能分级和慢性肾功能衰竭具有统计学意义。PVT 的发生率为 0.24/100 患者/年，首次发生在植入后 1000 多天。吸烟和瓣周组织形成与 PVT 显著相关。在不同位置的血栓患者之间，INR 变化无差异，但血栓形成前的 INR 与无血栓形成的患者有显著差异（INR=2.20[1.80-2.20]比 INR=2.80[2.20-3.40]；p=0.040）。卒中发生率和出血发生率分别为 4.4%和 5.2%。
该研究人群较为年轻，且风湿性瓣膜病在该人群中较为常见。尽管我们的样本收入低、教育水平低，但 PVT 的发生率与文献描述相似。
