N Engl J Med:生物瓣尽管不需抗凝,但15年死亡率明显高于机械瓣

2017-11-11 朱柳媛 中国循环杂志

目前的美国指南建议,对于50~70岁的主动脉瓣或二尖瓣瓣膜病患者,在行瓣膜置换术时既可以选择机械瓣,也可以选择生物瓣。近年来,尽管证据尚缺乏,但临床上越来越钟爱生物瓣。


目前的美国指南建议,对于50~70岁的主动脉瓣或二尖瓣瓣膜病患者,在行瓣膜置换术时既可以选择机械瓣,也可以选择生物瓣。近年来,尽管证据尚缺乏,但临床上越来越钟爱生物瓣。
 
11月9日,新英格兰医学杂志(NEJM)发表的美国斯坦福大学医学院的一项研究却发现,在相对年轻的心脏瓣膜病患者中,机械瓣带来的长期生存获益大于生物瓣。
 
具体来说,70岁以前行二尖瓣瓣膜置换术的患者以及55岁以前行主动脉瓣膜置换术的患者,从机械瓣中获益更大。
 
这项研究分析了加利福尼亚州1996-2013年心脏瓣膜置换的患者数据,发现在此期间,主动脉瓣和二尖瓣瓣膜置换术中生物瓣的使用率分别从11.5%、16.8%升至51.6%、53.7%。
 
在45~54岁接受主动脉瓣瓣膜置换术的患者中,生物瓣组的15年死亡率明显高于机械瓣组(30.6% vs. 26.4%);同样,在40~49岁(44.1% vs. 27.1%)以及50~69岁(50.0% vs. 45.3%)接受二尖瓣瓣膜置换术的患者中,生物瓣组的15年生存率均显著高于机械瓣组。
 
换生物瓣的患者再次手术的发生率高于换机械瓣的患者,但后者的出血累积发生率高于前者。换机械瓣的患者终身需要服用抗凝药物,而换生物瓣的患者大约10~15年需要再次换瓣。
 
原始出处:

Andrew B. Goldstone, Peter Chiu, Michael Baiocchi, et al. Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement. N Engl J Med 2017; 377:1847-1857.
 

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    2018-03-31 haouestc
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    2018-04-05 spoonycyy
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    2018-02-26 chg121
  5. [GetPortalCommentsPageByObjectIdResponse(id=1785500, encodeId=a1c81e85500a2, content=<a href='/topic/show?id=34b86e91f9' target=_blank style='color:#2F92EE;'>#Engl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6791, encryptionId=34b86e91f9, topicName=Engl)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7eeb2500172, createdName=haouestc, createdTime=Sat Mar 31 22:14:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081419, encodeId=8996208141902, content=<a href='/topic/show?id=57406e8506' target=_blank style='color:#2F92EE;'>#Eng#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6785, encryptionId=57406e8506, topicName=Eng)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Thu Apr 05 13:14:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635548, encodeId=bd0c163554857, content=<a href='/topic/show?id=83a3693965d' target=_blank style='color:#2F92EE;'>#生物瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69396, encryptionId=83a3693965d, topicName=生物瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ddce22497218, createdName=396094184_42047362, createdTime=Thu Aug 09 17:14:00 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2078755, encodeId=0f9f20e8755ec, content=<a href='/topic/show?id=a31661265fd' target=_blank style='color:#2F92EE;'>#机械瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61265, encryptionId=a31661265fd, topicName=机械瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7db99, createdName=chg121, createdTime=Mon Feb 26 05:14:00 CST 2018, time=2018-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1608228, encodeId=3b46160822871, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sun Nov 12 15:14:00 CST 2017, time=2017-11-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260413, encodeId=f49826041377, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Sat Nov 11 07:19:07 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260399, encodeId=f353260399b7, content=好太好了.好很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Sat Nov 11 05:41:11 CST 2017, time=2017-11-11, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1785500, encodeId=a1c81e85500a2, content=<a href='/topic/show?id=34b86e91f9' target=_blank style='color:#2F92EE;'>#Engl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6791, encryptionId=34b86e91f9, topicName=Engl)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7eeb2500172, createdName=haouestc, createdTime=Sat Mar 31 22:14:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081419, encodeId=8996208141902, content=<a href='/topic/show?id=57406e8506' target=_blank style='color:#2F92EE;'>#Eng#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6785, encryptionId=57406e8506, topicName=Eng)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Thu Apr 05 13:14:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635548, encodeId=bd0c163554857, content=<a href='/topic/show?id=83a3693965d' target=_blank style='color:#2F92EE;'>#生物瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69396, encryptionId=83a3693965d, topicName=生物瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ddce22497218, createdName=396094184_42047362, createdTime=Thu Aug 09 17:14:00 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2078755, encodeId=0f9f20e8755ec, content=<a href='/topic/show?id=a31661265fd' target=_blank style='color:#2F92EE;'>#机械瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61265, encryptionId=a31661265fd, topicName=机械瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7db99, createdName=chg121, createdTime=Mon Feb 26 05:14:00 CST 2018, time=2018-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1608228, encodeId=3b46160822871, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sun Nov 12 15:14:00 CST 2017, time=2017-11-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260413, encodeId=f49826041377, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Sat Nov 11 07:19:07 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260399, encodeId=f353260399b7, content=好太好了.好很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Sat Nov 11 05:41:11 CST 2017, time=2017-11-11, status=1, ipAttribution=)]
    2017-11-11 jihuaijun1112

    学习学习学习

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1785500, encodeId=a1c81e85500a2, content=<a href='/topic/show?id=34b86e91f9' target=_blank style='color:#2F92EE;'>#Engl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6791, encryptionId=34b86e91f9, topicName=Engl)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7eeb2500172, createdName=haouestc, createdTime=Sat Mar 31 22:14:00 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081419, encodeId=8996208141902, content=<a href='/topic/show?id=57406e8506' target=_blank style='color:#2F92EE;'>#Eng#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6785, encryptionId=57406e8506, topicName=Eng)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3516494, createdName=spoonycyy, createdTime=Thu Apr 05 13:14:00 CST 2018, time=2018-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635548, encodeId=bd0c163554857, content=<a href='/topic/show?id=83a3693965d' target=_blank style='color:#2F92EE;'>#生物瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69396, encryptionId=83a3693965d, topicName=生物瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ddce22497218, createdName=396094184_42047362, createdTime=Thu Aug 09 17:14:00 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2078755, encodeId=0f9f20e8755ec, content=<a href='/topic/show?id=a31661265fd' target=_blank style='color:#2F92EE;'>#机械瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61265, encryptionId=a31661265fd, topicName=机械瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7db99, createdName=chg121, createdTime=Mon Feb 26 05:14:00 CST 2018, time=2018-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1608228, encodeId=3b46160822871, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Sun Nov 12 15:14:00 CST 2017, time=2017-11-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260413, encodeId=f49826041377, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Sat Nov 11 07:19:07 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=260399, encodeId=f353260399b7, content=好太好了.好很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Sat Nov 11 05:41:11 CST 2017, time=2017-11-11, status=1, ipAttribution=)]
    2017-11-11 yjs木玉

    好太好了.好很好

    0

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