生物瓣置换术后晚期血栓形成原因及应对策略分析  

Reason Analysis and Prevention of Late Bioprosthetic Heart Valve Thrombosis

作　　者：张本[1,2] 王杨[2] 刘晓红[2] 张锡武[2] 龚德军[2] 唐昊[2] 徐志云[2] 

机构地区：[1]广州军区广州总医院心血管外科中心,广州510010 [2]第二军医大学长海医院胸心外科,上海200433

出　　处：《中国胸心血管外科临床杂志》2015年第4期292-297,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省自然科学基金资助项目(2014A030310473)~~

摘　　要：目的分析生物瓣置换术后晚期血栓（LBVT）的形成原因并提出应对策略。方法长海医院2001年1月至2013年7月间共580例患者行生物瓣置换术,仅1例（0.2%）出现LBVT。患者,男,67岁,主动脉瓣置换术后3年,因主动脉瓣重度狭窄再次行瓣膜置换术。回顾性分析该患者临床资料,并通过检索Pub Med数据库（1989年1月至2013年12月）对LBVT相关文献进行总结。结果该患者无致血栓高危因素,术中发现生物瓣窦内大量血栓,病理检查发现瓣叶纤维断裂。文献回顾共纳入20篇文献共47例患者,LBVT发病率为0.2%~1.0%,其中至少18例合并致血栓高危因素,此18例中有15例早期抗凝后未延长抗凝治疗;至少10例未合并任何高危因素而出现LBVT。44例患者使用猪瓣置换,仅1例使用牛心包瓣,余2例不明。结论 LBVT是生物瓣置换术后罕见且严重的并发症,其原因与患者和生物瓣本身均有关。牛心包瓣在预防血栓方面优于猪瓣。对无致血栓高危因素的患者,应抗凝3个月,然后终生抗血小板治疗;而如果存在高危因素,则应延长抗凝。Objective To analyze the reason and prevention of late bioprosthetic heart valve thrombosis（LBVT）. Methods Bioprosthetic heart valves were implanted in 580 patients between January 2001 and July 2013 in Changhai Hospital,and only found one case of LBVT（0.2%）. Reoperation was performed for a 67-year-old male patient 3 years after bioprosthetic aortic valve replacement due to severe aortic valve stenosis. Retrospectively analyzed the clinical data and reviewed the literature between January 1989 and December 2013 in Pubmed. Results No risk factor for thrombosis was revealed in this patient. Pathology revealed valve thrombosis and collagen and elastic fibers fragmentation and disruption in valve leaflets. In literature review, 20 articles and 47 cases were brought in. The morbidity of LBVT was 0.2%-1.0%. At least 18 patients had high risk factors, and 15 of the 18 patients discontinued anticoagulation after 3 months. However, at least 10 patients had no high risk factors. Forty-four of the 47 patients received stented porcine valve replacement, only one patient received stented bovine pericardial valve replacement. Conclusions LBVT is a rare but serious complication after bioprosthetic valve replacement, the causes of which include the feature of the patients and the bioprosthetic valves. Bovine pericardial valves could be superior to porcine valves in preventing LBVT. Postoperative long-time aspirin therapy is recommended for patients without high risk factors. Patients with any high risk factors should prolong anticoagulation.

关 键 词：人工心脏瓣膜 生物瓣 血栓 预防 

分 类 号：R654.2[医药卫生—外科学]