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Circ: Cardiovascular Interventions:经导管主动脉瓣中瓣置入术后的临床瓣膜血栓形成

2018-11-18 xiangting MedSci原创

经导管主动脉ViV植入术后的临床瓣膜血栓形成很常见,尤其是未接受口服抗凝治疗的患者。

关于经导管主动脉瓣中瓣(ViV)植入术后临床瓣膜血栓形成的数据有限。这项研究目标是确定诊断为临床ViV血栓形成患者的发病率、时间、临床特征和治疗结局。

对参与瓣中瓣国际数据登记中心的血栓形成病例进行调查,临床瓣膜血栓形成的定义是基于同时存在新的瓣膜功能障碍和小叶血栓的影像证据。纳入300个ViV植入术。86.3%的病例植入支架,13.7%无支架;50%病例的经导管心脏瓣膜为自扩张,49%为球囊扩张,1.0%为机械扩张。临床瓣膜血栓形成的发病率为7.6%(n=23),术后诊断的中位时间为101天(四分位间距,21-226)。15名患者(65%)出现症状恶化,21名患者(91%)跨瓣平均梯度升高。诊断时的平均梯度(中位数39mmHg;四分位间距,30-44)显著高于ViV后的即刻梯度(13mmHg;四分位间距, 8-20.5; P<0.001),并在口服抗凝治疗后显著降低(17.5mmHg;四分位间距,11-20.5; P<0.001)。没有与瓣膜血栓形成有关的死亡或中风。与瓣膜血栓形成相关的因素是口服抗凝(比值比[95%CI]:0.067 [0.008-0.543],P=0.011)、外科瓣膜真实内径与体表面积的指数(0.537 [0.331-0.873],P=0.012)、Mosaic或Hancock II支架猪生物假体(4.01 [1.287-12.485],P=0.017)。

经导管主动脉ViV植入术后的临床瓣膜血栓形成很常见,尤其是未接受口服抗凝治疗的患者。虽然主动脉ViV通常与梯度升高相关,但如果与术后早期值相比梯度升高,则应排除瓣膜血栓形成。观察到使用某些类型的支架猪手术瓣膜治疗后的发病率更高,表明在该ViV患者亚组中需要对辅助抗血栓治疗进行特定调整。

原始出处:

Mohamed Abdel-Wahab. Clinical Valve Thrombosis After Transcatheter Aortic Valve-in-Valve Implantation. Circ: Cardiovascular Interventions. 16 November 2018.

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    2019-06-05 quxin068
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encodeId=4a831510168b1, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Tue Nov 20 07:51:00 CST 2018, time=2018-11-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583594, encodeId=7f22158359455, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Tue Nov 20 07:51:00 CST 2018, time=2018-11-20, status=1, ipAttribution=)]
    2019-02-08 huangdf
  5. 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2018, time=2018-11-20, status=1, ipAttribution=)]
  6. 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  7. 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  8. 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    2018-11-20 lsj631
  9. 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