EUR HEART J :主动脉瓣置换术——机械瓣膜vs.生物瓣膜

2017-07-25 MedSci MedSci原创

近日,在医学权威杂志EUR HEART J 上面发表了一篇研究文章,研究人员旨在探讨主动脉瓣置换术中机械瓣膜与生物瓣膜的应用比较。

近日,在医学权威杂志EUR HEART J 上面发表了一篇研究文章,研究人员旨在探讨主动脉瓣置换术中机械瓣膜与生物瓣膜的应用比较。

由于抗凝治疗,机械瓣膜用于主动脉瓣置换术(AVR)仍然与出血风险有关,而生物瓣膜则面临结构瓣膜恶化需要再次手术的风险。由于机械瓣膜和生物瓣膜的风险/收益比率,美国和欧洲关于心脏瓣膜病的指导方针一致建议60岁以上的病人使用机械假体。尽管有这些建议,在过去几十年里,所有年龄组的人造生物瓣膜的使用量显着增加。

研究人员运用倾向匹配或多变量分析方法进行了一项系统回顾,比较机械瓣膜与生物瓣膜的使用情况,发现两种类型的瓣膜结局相似,机械假体的有利结局也相似(尤其是在较年轻的病人身上)。阀门设计的发展、抗凝治疗、降低国际标准化比率,以及经导管的和微创性的瓣膜手术,都将影响到阀门的风险/效益比率和瓣膜的选择。然而,目前没有证据支持降低生物瓣膜移植的年龄门槛。

由此可见,在追求更多的生物瓣膜使用时,心脏病医生团队和病人应该小心谨慎,直到瓣膜对于中年患者的益处得到明确证实。

原始出处
Stuart J. Headm, Mevlüt Celik, A. Pieter Kappetein, et al. Mechanical versus bioprosthetic aortic valve replacement. EUR HEART J. 2017 July.

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    2017-09-03 yxch48
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    2017-11-01 chg121
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createdName=chg121, createdTime=Wed Nov 01 08:47:00 CST 2017, time=2017-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635545, encodeId=2bfa16355453f, 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=35, 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=Tue Oct 31 04:47:00 CST 2017, time=2017-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332442, encodeId=bc851332442a6, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356428, encodeId=1ab61356428a9, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367093, encodeId=775f136e0937e, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1399085, encodeId=94431399085aa, content=<a href='/topic/show?id=49dd69399c2' target=_blank style='color:#2F92EE;'>#生物瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69399, encryptionId=49dd69399c2, topicName=生物瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/SicjCIAeTxGf3PibxsFPgEb3xtbibdR8KpjNN5V3XkiatR1BXv2o9YPVhSnazedCHtUUh9KJyUmqYnmS3fRlyJZ4Dw/132, createdBy=5c342186905, createdName=liao1620, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415176, encodeId=4cb214151e6c3, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562632, encodeId=042f156263223, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576562, encodeId=a59015e65625c, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1742414, encodeId=95d81e42414b7, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Sun Sep 03 09:47:00 CST 2017, time=2017-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2078753, encodeId=f4ed20e8753a8, 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=41, 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=Wed Nov 01 08:47:00 CST 2017, time=2017-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635545, encodeId=2bfa16355453f, 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=35, 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=Tue Oct 31 04:47:00 CST 2017, time=2017-10-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332442, encodeId=bc851332442a6, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356428, encodeId=1ab61356428a9, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1367093, encodeId=775f136e0937e, content=<a href='/topic/show?id=b6222320322' target=_blank style='color:#2F92EE;'>#主动脉瓣置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1399085, encodeId=94431399085aa, content=<a href='/topic/show?id=49dd69399c2' target=_blank style='color:#2F92EE;'>#生物瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69399, encryptionId=49dd69399c2, topicName=生物瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/SicjCIAeTxGf3PibxsFPgEb3xtbibdR8KpjNN5V3XkiatR1BXv2o9YPVhSnazedCHtUUh9KJyUmqYnmS3fRlyJZ4Dw/132, createdBy=5c342186905, createdName=liao1620, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415176, encodeId=4cb214151e6c3, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562632, encodeId=042f156263223, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1576562, encodeId=a59015e65625c, content=<a href='/topic/show?id=48fee966468' target=_blank style='color:#2F92EE;'>#置换术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79664, encryptionId=48fee966468, topicName=置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=)]
    2017-07-27 zhaojie88
  6. [GetPortalCommentsPageByObjectIdResponse(id=1742414, encodeId=95d81e42414b7, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Sun Sep 03 09:47:00 CST 2017, time=2017-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2078753, encodeId=f4ed20e8753a8, 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=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61265, encryptionId=a31661265fd, topicName=机械瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7db99, 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  7. 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  8. [GetPortalCommentsPageByObjectIdResponse(id=1742414, encodeId=95d81e42414b7, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Sun Sep 03 09:47:00 CST 2017, time=2017-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2078753, encodeId=f4ed20e8753a8, 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=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61265, encryptionId=a31661265fd, topicName=机械瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7db99, 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  9. [GetPortalCommentsPageByObjectIdResponse(id=1742414, encodeId=95d81e42414b7, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Sun Sep 03 09:47:00 CST 2017, time=2017-09-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2078753, encodeId=f4ed20e8753a8, 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=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=61265, encryptionId=a31661265fd, topicName=机械瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7db99, 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channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23203, encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1399085, encodeId=94431399085aa, content=<a href='/topic/show?id=49dd69399c2' target=_blank style='color:#2F92EE;'>#生物瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69399, encryptionId=49dd69399c2, topicName=生物瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/SicjCIAeTxGf3PibxsFPgEb3xtbibdR8KpjNN5V3XkiatR1BXv2o9YPVhSnazedCHtUUh9KJyUmqYnmS3fRlyJZ4Dw/132, createdBy=5c342186905, createdName=liao1620, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415176, encodeId=4cb214151e6c3, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Thu Jul 27 14:47:00 CST 2017, time=2017-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562632, encodeId=042f156263223, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, 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    2017-07-27 slcumt
  10. 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对于无症状严重主动脉瓣狭窄(AS)患者主动脉瓣置换术(AVR),目前的指南一般建议观察等待,直到症状出现。该研究旨在比较诊断为无症状严重AS患者进行初始AVR vs 保守策略的长期随访结果。在2003年1月和2011年12月之间,研究人员使用了来自一个大型多中心注册登记的连续3815例严重AS患者的数据(主动脉射流速度峰值> 4.0 m/s,或平均动脉压梯度>40mm Hg,或主动脉瓣区&l

LANCET:手术和经导管主动脉瓣置换术哪个更好?

经导管瓣置换术(TAVR)和手术主动脉瓣置换术(SAVR)后生物假体主动脉瓣的亚临床瓣膜血栓形成已被CT检查显示。近期,一项发表在权威杂志LANCET上的研究旨在评估外科和经导管主动脉瓣中亚临床瓣膜血栓形成的发生率和新型口服抗凝剂(NOAC)对亚临床瓣膜血栓形成和随后的血流动力学以及临床结果的影响。此项研究对2014年12月22日至2017年1月18日在RESOLVE登记以及2014年6月2日至2

Circulation:临床疲劳量表对经导管主动脉瓣置换术后的影响

半定量临床疲劳量表(CFS)是一种评估患者的虚弱程度的简单工具,其与老年患者的死亡率相关。近期,一项发表在杂志Circulation上的研究旨在确定CFS在接受经导管主动脉瓣置换术(TAVR)患者的预后价值。研究者们利用优化的CathEter vAlvular iNtervention(OCEAN)日本多中心注册表审查了1215例接受TAVR患者的数据。基于CFS阶段将患者分为5组:CFS1-3,

JACC:主动脉瓣置换术可降低保守LEVF和低梯度的主动脉瓣狭窄患者的死亡率

低平均跨瓣压力梯度(<40mm Hg)和主动脉瓣面积小(<1.0cm2)的患者并患有主动脉瓣狭窄(AS)和保守左室射血分数引起了人们对主动脉瓣置换术(AVR)的狭窄和生存利益的实际严重程度的不确定性。这项研究分析了AVR对低梯度(LG)AS和保守左室射血分数患者死亡率和存活率的影响,包括反常的低流量(即每搏输出量指数<35ml/m2),低梯度(LF-LG)和正常流量,低梯度(NF

JAHA:纵隔放射相关的严重主动脉瓣狭窄和主动脉瓣置换术患者的长期预后如何?

由此可见,在接受SAVR的重度主动脉瓣狭窄患者中,既往进行纵隔XRT的患者相比于对照组其长期生存预后较差。

JACC:重度主动脉瓣狭窄患者的介入治疗与主动脉瓣置换术

    背景  经导管主动脉瓣置换术(TAVR)是在一定的高风险手术的严重主动脉瓣狭窄患者的一个选择。但并不知道是否可以将TAVR安全地引入到低风险患者。    意义  在NOTION(北欧主动脉瓣膜干预试验)随机临床试验中,比较所有研究队列的患者接受主动脉瓣置换手术(SAVR)和TAVR的区别。    方法 &nbs