Callegari Alessia, Butera Gianfranco, Krasemann Thomas, Heying Ruth, Michel-Behnke Ina, Bonnet Damien, Malekzadeh-Milani Sophie
Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants-Malades, AP-HP, rue de Sèvres, 75015 Paris, France.
Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, 00165 Rome, Italy.
Arch Cardiovasc Dis. 2025 Jun 12. doi: 10.1016/j.acvd.2025.04.056.
Despite the widespread adoption of percutaneous pulmonary valve implantation, there remains a lack of consensus on the optimal management of peri-interventional and long-term antithrombotic therapies because of a lack of evidence.
To clarify current practices in peri/postprocedural antithrombotic strategies for percutaneous pulmonary valve implantation.
An online survey was submitted to the Interventional Working Group of the Association for European Paediatric and Congenital Cardiology, and was completed by 76 congenital interventional cardiologists in 2023-2024.
Overall, 86% had standardized protocols for anticoagulation/antiaggregation. Intraprocedural heparin administration of 100IU/kg was common (83%), and postprocedural strategies mostly included acetylsalicylic acid (aspirin) (45%) or a combination of antiaggregation and anticoagulation (29%). Long-term strategies comprised antiaggregation (88%), no therapy (11%) and anticoagulation only (1%). Acetylsalicylic acid monotherapy was prescribed by 91%, whereas 9% used dual antiaggregation therapy. Dual antiaggregation therapy was continued for suspicious medical history of thrombotic complication or microthrombi for 3-6 months. Testing for acetylsalicylic acid resistance was infrequent (36%), and only if clinically indicated. When patients had pre-established anticoagulation therapy, 59% changed their strategy. Treatment changes based on valve type were rare (8%). The primary reasons for anticoagulation/antiaggregation were to increase valve longevity (26%) and for both longevity and endocarditis prophylaxis (68%). Acute valve thrombosis was reported in 11 cases.
The survey reveals variability in practices after percutaneous pulmonary valve implantation. Most interventional cardiologists prefer acetylsalicylic acid for postprocedural and long-term management, whereas dual antiaggregation therapy is sometimes used in specific cases. Anticoagulation is limited to pre-existing therapy cases or isolated experiences for 3 months.
尽管经皮肺动脉瓣植入术已广泛应用，但由于缺乏证据，对于围手术期和长期抗血栓治疗的最佳管理仍未达成共识。
阐明经皮肺动脉瓣植入术围手术期/术后抗血栓策略的当前实践。
向欧洲儿科和先天性心脏病协会介入工作组提交了一项在线调查，并于2023 - 2024年由76位先天性介入心脏病专家完成。
总体而言，86%的人有抗凝/抗聚集的标准化方案。术中给予100IU/kg肝素很常见（83%），术后策略大多包括乙酰水杨酸（阿司匹林）（45%）或抗聚集与抗凝联合使用（29%）。长期策略包括抗聚集（88%）、不进行治疗（11%）和仅抗凝（1%）。91%的人开具乙酰水杨酸单药治疗，而9%的人使用双联抗聚集治疗。对于有血栓形成并发症或微血栓可疑病史的患者，双联抗聚集治疗持续3 - 6个月。很少进行乙酰水杨酸抵抗检测（36%），仅在临床有指征时进行。当患者有预先确立的抗凝治疗时，59%的人改变了他们的策略。基于瓣膜类型改变治疗的情况很少见（8%）。抗凝/抗聚集的主要原因是提高瓣膜寿命（26%）以及同时提高瓣膜寿命和预防心内膜炎（68%）。报告了11例急性瓣膜血栓形成病例。
该调查揭示了经皮肺动脉瓣植入术后实践的差异。大多数介入心脏病专家在术后和长期管理中更喜欢使用乙酰水杨酸，而双联抗聚集治疗有时用于特定情况。抗凝仅限于已有治疗的病例或3个月的个别经验。
