生物瓣置换术后早期衰败原因分析与应对策略:3例报告并文献回顾

Cause analysis and coping strategy of early bioprosthesis failure:a report of three cases and literature review

目的分析生物瓣置换术后早期衰败(EBF)原因并探讨应对策略。方法回顾长海医院2001年1月到2014年1月间接受生物瓣置换术后EBF患者的临床资料,并利用PubMed以"bioprosthesis"、"heart valve prosthesis"、"early failure"、"bioprosthesis failure"为关键词对1994年至2014年间发表的EBF相关文献进行检索并回顾分析。结果 2001年1月至2014年1月间长海医院收治的650例生物瓣置换术者中有3例发生EBF(占0.5%),EBF原因分别为自身瓣叶粘连、代谢综合征导致生物瓣早期钙化、早期生物瓣血栓形成。文献回顾收集14例EBF病例,其中生物瓣与自身瓣叶粘连6例(42.9%);患者本身代谢异常3例(21.4%);术后早期生物瓣血栓形成2例(14.3%);慢性炎症反应2例(14.3%);手术操作不当1例(7.1%)。结论 EBF较少见,其形成原因复杂多样,应根据患者不同情况制定相应的预防措施。

Objective To analyze the causes of early bioprosthesis failure（EBF） and to discuss its coping strategy. Methods The clinical data of patients who received bioprosthesis replacement in Changhai Hospital between Jan. 2001 and Jan. 2014 were reviewed. We also searched PubMed for related articles which were published from 1994 to 2014 using ＂bioprosthesis＂, ＂heart valve prosthesis＂, ＂early failure＂ and ＂bioprosthesis failure＂ as the keywords. Results Only three EBF cases （0. 5 %） were found among a total of 650 cases who received bioprosthesis replacement in our hospital, and the reasons for EBF in the 3 cases were： native valve attachment, early calcification caused by metabolic syndrome, and early valve thrombosis. Pubmed searched identified 14 EBF case reports, and the reasons for these 14 cases were as follows： native valve attachment in 6（42. 9%） cases, metabolic abnormalities in 3（21.4%） cases, early valve thrombosis in 2（14.3%） cases, chronic inflammation in 2（14. 3%） cases, and improper operation in 1 （7. 1%） case. Conclusion EBF is a rare but serious complication after bioprosthesis replacement, with complicated causes. Appropriate preventive measures should be applied according to the different conditions of patients.