病人选择和操作方法机械瓣vs生物瓣主动脉瓣替换西方观点英文.pptxVIP

病人选择和操作方法 :机械瓣 vs 生物瓣主动脉瓣替换西方观点“The ideal prosthetic valve would have excellent hemodynamics (similar to a normal human valve in the same position), last a lifetime, be free of structural dysfunction or breakdown, and require no particular medical therapy such as anticoagulation. Needless to say, such a valve is yet to be available.”推荐 “新”的好的瓣膜与“旧”的好的瓣膜结果相似。生物瓣在老年病人中结构性瓣膜毁损率低。在 60 to 65 病人是首选推荐 新的生物瓣和机械瓣有更好的血流动力学。耐久性和病人死亡率比旧的生物瓣更好单纯根据病人年龄来决定采用什么瓣膜可能不能为个体病人作出正确的决策。or?前瞻性随机研究Edinburgh Heart Valve Trial533 patients; 1975 to 1979Bjork-Shiley vs. porcine (Hancock, Carpentier-Edwards)Bloomfield, et al. New Engl J Med 1991;324:573-9.Oxenham, et al. Heart 2003;89:715-21.Veterans Affairs Cooperative Study575 patients; 1977 to 1982Bjork-Shiley vs. HancockHammeremister, et al. New Engl J Med 1993;328:1289-96.Hammermeister, et al. J Am Coll Cardiol 2000;36:1152-8.生存率 Edinburgh Heart Valve Trial100806040200P=0.39%Bjork-ShileyPorcinears after randomizationSource: H死亡率VA Cooperative Study100806040200P=0.02BioprosthesisMortality%MechanicalProsthesis0246810121416Years after valve replacementHammermeister et al., JACC:2000瓣膜相关性并发症VA Cooperative Study100806040200P=0.26MechanicalProsthesisAll Valve-related Complications%Bioprosthesis0246810121416Years after valve replacementHammermeister et al., JACC:2000出血VA Cooperative Study100806040200P=0.0001MechanicalProsthesisBleeding%Bioprosthesis0246810121416Years after valve replacement瓣膜功能障碍VA Cooperative Study100806040200P=0.0001Bleeding%BioprosthesisMechanicalProsthesis0246810121416Years after valve replacementHammermeister et al., JACC:2000再次手术VA Cooperative Study100806040200P=0.004All Reoperations %BioprosthesisMechanicalProsthesis0246810121416Years after valve replacementHammermeister et al., JACC:2000生物瓣 vs. 机械瓣AHA/ACC 标准 采用生物瓣的年龄标准是基于65岁以上病人结构性瓣膜毁损明显下降和出血风险明显升高决定的。年龄主要的瓣膜选择标准≥ 65 - 70 岁: 生物瓣 65 - 70 岁: 机械瓣AHA/ACC 指南避免 华法林风险再次手术个体病人什么是华法林风险？什么是再次手术的风险？机械瓣风险年龄 vs INR 出血的时间75th percentile50th percentile25th percentileWittkowsky