机械瓣还是生物瓣——人工瓣的选择及讨论

Choices for valve replacement: mechanical prosthesis or bioprosthesis

人工心脏瓣膜主要包括机械瓣膜和生物瓣膜两大类,两类瓣膜各有特点。患者年龄是选择瓣膜的重要参考因素。目前对于患者的瓣膜选择尚存争议,2012版欧洲心脏病指南对于60~65岁患者的主动脉瓣置换以及65~70岁患者的二尖瓣置换未予以倾向性的人工瓣选择建议,2014版美国心脏病指南对于60~70岁患者的人工瓣选择未予以倾向性建议(2017年美国心脏病协会再次对指南进行修改,50~70岁患者不再予以瓣膜选择建议)。本综述对目前人工瓣膜置换术后的疗效进行对比分析,并对不同年龄人群的瓣膜选择进行讨论。

The prosthetic heart valve includes mechanical prosthesis and bioprosthesis which have different features and benefits. The patient＇s age is the most important decisive factor to decide which kind of prosthetic valve will be used. The optimal choice of prosthesis still requires further study. The 2012 European Society of Cardiology（ECS） guideline has no recommendation for valve choice on aortic valve for patients aging 60-65 years and on mitral valve for patients aging 65-70 years. The 2014 American Heart Association（AHA） guideline has no recommendation for all valves for patients aging 60-70 years（the age was modified to 50-70 years in 2017）. In this review we analyze the studies about the prognosis of prosthetic valve replacement and discuss how to choose it for patients in different ages.