Zhao Yichen, Zhao Cheng, Ye Qing, Li Fei, Liu Kemin, Zhao Shihua, Wang Jiangang
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Magnetic Resonance Imaging, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Ann Thorac Cardiovasc Surg. 2023 Oct 20;29(5):223-232. doi: 10.5761/atcs.oa.22-00213. Epub 2023 Mar 3.
This study aimed to illustrate how percutaneous balloon mitral valvuloplasty (PBMV) and mitral valve (MV) surgeries influence women of childbearing age with rheumatic mitral valve diseases (RMVDs) from two aspects, including clinical outcomes and their postoperative childbearing performances.
Female patients with RMVD who were of childbearing age and underwent MV interventions between 2007 and 2019 at Beijing Anzhen Hospital were identified. Outcomes included all-cause deaths, repeated MV interventions, and atrial fibrillation. A survey about childbearing attempts and complications during pregnancy was also performed during follow-up.
A total of 379 patients were involved in this study, consisting of 226 cases of mitral valve replacements, 107 cases of mitral valve repairs (MVrs), and 46 cases of PBMVs. PBMV was associated with higher possibilities of repeated MV interventions (P <0.05). Postoperative childbearing attempts were more frequently observed among bioprosthesis, MVr, and PBMV (P <0.05). However, PBMV and MVr showed a higher incidence of cardiac complications during pregnancy as compared to prosthesis replacement (P <0.05).
MVr and PBMV are not recommended to young female patients for higher incidences of postoperative complications. Safe pregnancy is more likely to be present among patients with biological prosthesis.
本研究旨在从临床结局及其术后生育表现两个方面，阐明经皮球囊二尖瓣成形术（PBMV）和二尖瓣（MV）手术对育龄期风湿性二尖瓣疾病（RMVD）女性的影响。
确定2007年至2019年在北京安贞医院接受MV干预的育龄期RMVD女性患者。结局包括全因死亡、重复MV干预和心房颤动。在随访期间还进行了关于妊娠期间生育尝试和并发症的调查。
本研究共纳入379例患者，包括226例二尖瓣置换术、107例二尖瓣修复术（MVr）和46例PBMV。PBMV与重复MV干预的可能性较高相关（P<0.05）。生物瓣膜、MVr和PBMV术后生育尝试更为常见（P<0.05）。然而，与人工瓣膜置换相比，PBMV和MVr在妊娠期间心脏并发症的发生率更高（P<0.05）。
由于术后并发症发生率较高，不建议年轻女性患者进行MVr和PBMV。生物人工瓣膜患者更有可能实现安全妊娠。
