“Mitral valve replacement”的意思、由来-开放百科全书

In a study of 99 patients who had mitral valve surgery for regurgitation from January 1990 to June 1996, overall mortality was 4%, which included 3 operative deaths and 4 late deaths. Overall 5-year survival rate was 92%.^[7]

Risks

With mitral valve replacement surgery, there are risks such as bleeding, infection or reaction to anesthesia.^[2] Risks depend on a patient’s age, general condition, specific medical conditions, and heart function.^[1] Neuropsychological and psychopathologic changes following mitral valve replacement surgery have been recognized from the very beginning of modern heart surgery.

Variables correlated with nonpsychotic mental disorder after cardiac surgery must be divided into pre-, intra- and postoperative. The incidence, phenomenology, and duration of symptoms diverge from patient to patient, and are difficult to define. One wonders whether any of the patients in either group in this analysis underwent any mechanical cardiac valve replacement. If so, one has to consider Skumin syndrome, described by Victor Skumin in 1978 as a “cardioprosthetic psychopathological syndrome”^[6]^[7] associated with mechanical heart valve implant and manifested by irrational fear, anxiety, depression and sleep disorder.^[8]

Postoperative complications

A common postoperative complication with mitral valve surgery in a study involving 99 patients who had surgery for mitral regurgitation from January 1990 to June 1996 is atrial fibrillation. This occurred in 32% of patients. A common pulmonary complication is congestion necessitating prolonged use of oxygen. Other patients required prolonged ventilation of longer than 24 hours for conditions like pulmonary edema, ARDS, and pulmonary thromboemboli ^[9] Nine patients had renal failure with six of them dying within 30 days after their operation. Five patients had permanent strokes, and nine patients were readmitted to the hospital within 30 days of their discharge.^[9]

Artificial valve types

There are two primary types of artificial mitral valves: mechanical valves and bioprosthetic tissue (biological) valves.^[15] The mechanical valves are made from metal and pyrolytic carbon, and can last a lifetime.^[1] Patients with mechanical valves must take blood-thinning medications to prevent clotting. Bioprosthetic valves are made from animal tissues.^[1] Use of these biological valves allows patients to avoid blood thinners. However, the bioprosthetic valves may only last 10 to 15 years.^[15] The choice of which valve type to use depends upon the patient's age, medical condition, preferences with medication, and lifestyle.^[1]

Procedure

People having mitral valve surgery receive general anesthesia.^[2] Incision can be made somewhat horizontally under the left breast, or vertically through the sternum. After the heart is exposed, canulae are placed to reroute blood to a heart-lung machine for cardiopulmonary bypass.^[2] An incision is made in the left atrium to expose the mitral valve. The valve is then replaced with either a biological or mechanical valve. The left artium is then closed, and the patient weaned from cardiopulmonary bypass. After surgery patients are typically taken to an intensive care unit (ICU).^[2]

Mitral valve surgery can now also be performed robotically although the procedure may take longer.^[10]

Transcatheter approach

New Developments (2014 -2017): Transcatheter mitral valve replacement or TMVR^[11] involves human heart mitral valve replacement without recourse to open-heart surgery. TMVR treats mitral valve stenosis and/or mitral valve regurgitation leading to mitral insufficiency. TMVR, initially developed by the company Tendyne (a subsidiary of Jean Boulle Medtech Ltd) for open-heart high risk patients is expected to replace traditional mitral valve replacement surgery in the longer term.^[12] The Tendyne mitral valve is placed inside a beating heart via a transcatheter at the bottom of the heart through a tube inserted in a small incision in the patient’s chest. The physician uses the tube to deploy the valve and positions it so that it rests over the heart's existing mitral valve. It is then anchored securely in place by an adjustable tether. The valve is fully retrievable, totally repositionable and is sewn onto a Nitinol frame. Nitinol is a superelastic nickel and titanium "shape memory alloy" whose flexibility eases implantation, but regains its original shape when it returns to a patient’s normal body temperature.

The transition of TMVR from concept to reality occurred during the period 2014 -2017.^[13]

Recovery

After the surgery the person is taken to a post-operative intensive care unit for monitoring. A respirator may be required for the first few hours or days after surgery. After a day, the patient should be able to sit up in bed. After two days, the patient may be taken out of the intensive care unit. Patients are usually discharged after about seven to ten days.^[2] If the mitral valve replacement is successful, patients can expect to return to their regular condition or even better.

Patients who have biological valve are prescribed blood thinners (anticoagulants) with warfarin for 6 weeks to 3 months postoperative, while patients with mechanical valves are prescribed blood thinners for the rest of their lives. These blood thinners are taken to prevent blood clots that can move to other parts of the body and cause serious medical problems, such as a heart attack. Blood thinners will not dissolve a blood clot but they prevent other clots from forming or prevent clots from becoming larger.^[14]

Once the person’s wounds are healed they should have few, if any, restrictions from daily activities.^[1] People are advised to walk or undertake other physical activities gradually to regain strength. Patients who have physically demanding jobs will have to wait a little longer than those who don’t. Patients are also restricted from driving a car for six weeks after the surgery.^[2]

Once a person has a mitral valve procedure, they are required to have prophylactic antibiotics as a preventative measure against infection whenever they have dental work done.^[1] Some scarring occurs after surgery. For median sternotomy (access through the sternum, or breastbone), the patient will have a vertical scar on the anterior chest above the sternum. If the heart is accessed from under the left breast there will be a smaller scar in this location.^[2]

Alternatives

Repair

Many mitral valves can be repaired instead of replaced, especially for minimally damaged valves.^[1] Advantages to valve repair instead of replacement include lower surgical mortality (1-2% for repair versus 6-8% for replacement), lower risk of stroke, lower rate of endocardial infection, and improved long-term survival.

Patients who receive a valve repair stay on the same survival curve as the normal population. After mitral valve repair, blood thinners are not required; however, lifelong maintenance on blood thinners is required after mechanical mitral valve replacement.^[15]

Non-surgical options

For individuals with few symptoms, or those with contraindications to surgery, there are options for medical treatment in both mitral insufficiency and mitral valve stenosis, although they are non-curative. For both conditions, such medical treatments may include diuretics,^[16]^[17] vasodilators,^[17]^[16] and ACE inhibitors^[16]^[18]^[19].

See also

References

1. ^¹²³⁴⁵⁶⁷⁸{{cite web|last=Sundt|first=Thoralf M.|title=Mitral Valve Repair|url=http://www.sts.org/patient-information/valve-repair/replacement-surgery/mitral-valve-repair|publisher=The Society of Thoracic Surgeons|accessdate=18 February 2012}}
2. ^¹²³⁴⁵⁶⁷{{cite web|title=Mitral Valve Repair/Replacement|url=http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=mitral+valve+repair+replacement&content_id=274|publisher=Baylor College of Medicine|accessdate=18 February 2012}}
3. ^{{cite journal | last1 = Bertazzo | first1 = S. |display-authors=etal | year = 2013 | title = Nano-analytical electron microscopy reveals fundamental insights into human cardiovascular tissue calcification | url = | journal = Nature Materials | volume = 12 | issue = | pages = 576–583 | doi=10.1038/nmat3627}}
4. ^{{cite journal | last1 = Miller | first1 = J. D. | year = 2013 | title = Cardiovascular calcification: Orbicular origins | url = | journal = Nature Materials | volume = 12 | issue = | pages = 476–478 | doi=10.1038/nmat3663}}
5. ^{{cite web|title=Valvular Heart Disease|url=http://www.lahey.org/Departments_and_Locations/Departments/Heart_and_Vascular_Center/Valvular_Heart_Disease.aspx?_vsignck&_vsrefdom=vascular2|publisher=Lahey Clinic Foundation|accessdate=18 February 2012}}
6. ^{{cite journal |last3=Skumin |first3=V. A. |last2=Morozov |first2=S. M. |url=http://biblmdkz.ru/articles/kardiologiia.html |last1=Bendet |first1=Ya. A. |title=Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects |year=1980 |script-title=ru: Psikhologicheskie aspekty reabilitatsii bol'nykh posle khirurgicheskogo lecheniia porokov serdtsa |trans-title=Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects |journal=Kardiologiia |volume=20 |issue=6 |pages=45–51 |oclc=114137678 |pmid=7392405 |deadurl=yes |archiveurl=https://www.webcitation.org/6wAuZ2Ar5?url=http://biblmdkz.ru/articles/kardiologiia.html |archivedate=2018-01-02 |df= }}
7. ^{{cite journal|last=Skumin|first=V. A.|date=1982|url=http://biblmdkz.ru/articles/nmd.html|script-title=ru: Nepsikhoticheskie narusheniia psikhiki u bol'nykh s priobretennymi porokami serdtsa do i posle operatsii (obzor)|journal=Zhurnal nevropatologii i psikhiatrii imeni S.S. Korsakova|volume=82|pages=130–5|oclc=112979417|pmid=6758444|trans-title=Nonpsychotic mental disorders in patients with acquired heart defects before and after surgery (review)|deadurl=yes|archiveurl=https://www.webcitation.org/6wAYHGzbC?url=http://biblmdkz.ru/articles/nmd.html|archivedate=2018-01-02|df=}}
8. ^Ruzza, Andrea. ″Nonpsychotic mental disorder after open heart surgery″ Asian Cardiovascular and Thoracic Annals (2013)
9. ^¹²{{cite journal|last=Knott|first=Hurley W.|title=Clinical study of mitral valve repair: short-term and long-term outcomes.|journal=Southern Medical Journal|date=Jan 1999|volume=92|issue=1|pages=33–40|pmid=9932824|url=https://www.ncbi.nlm.nih.gov/pubmed?term=9932824|accessdate=18 February 2012|doi=10.1097/00007611-199901000-00006}}
10. ^{{cite journal|title=Mitral valve repair robotic versus sternotomy|last=Folliguet|first=T|author2=Vanhuyse F |author3=Constantino X |author4=Realli M |author5=Laborde F |journal=Eur J Cardiothorac Surg|date=Mar 2006|volume=29|issue=3|pages=362–6|pmid=16423535|doi=10.1016/j.ejcts.2005.12.004}}
11. ^{{cite journal|title=Transcatheter mitral valve replacement: an evolution of a revolution|journal=Journal of Thoracic Disease|pmc=5505942 | pmid=28740722|doi=10.21037/jtd.2017.05.60|volume=9|year=2017|pages=S668-S672 | last1 = Alkhouli | first1 = M | last2 = Alqahtani | first2 = F | last3 = Aljohani | first3 = S}}
12. ^{{cite web|url=https://myheart.net/articles/tmvr-transcatheter-mitral-valve-replacement/|title=Transcatheter Mitral Valve Replacement – TMVR Explained|publisher=My Heart|accessdate=24 Feb 2018}}
13. ^{{cite web|url=https://www.mdedge.com/ccjm/article/120398/cardiology/transcatheter-mitral-valve-replacement-frontier-cardiac-intervention|title=Transcatheter mitral valve replacement: A frontier in cardiac intervention|publisher=Cleveland Clinic Journal of Medicine 2017 November; 83(suppl 2):S10-S17|accessdate=24 Feb 2018}}
14. ^{{cite web|title=Warfarin and Other Blood Thinners for Heart Disease|url=http://www.webmd.com/heart-disease/warfarin-other-blood-thinners?page=1|publisher=WebMD|accessdate=18 February 2012}}
15. ^¹²{{cite web|title=Mitral Valve Repair and Replacement|url=http://www.umm.edu/heart/mitral_repla.htm|publisher=Maryland Heart Center|accessdate=18 February 2012}}
16. ^¹²VOC=VITIUM ORGANICUM CORDIS, a compendium of the Department of Cardiology at Uppsala Academic Hospital. By Per Kvidal September 1999, with revision by Erik Björklund May 2008
17. ^¹{{cite book |author1=Elizabeth D Agabegi |author2=Agabegi, Steven S. |title=Step-Up to Medicine (Step-Up Series) |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2008 |pages= |isbn=978-0-7817-7153-5 |oclc= |doi= |accessdate=}} Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease
18. ^{{cite journal |vauthors=Greenberg BH, Massie BM, Brundage BH, Botvinick EH, Parmley WW, Chatterjee K |title=Beneficial effects of hydralazine in severe mitral regurgitation |journal=Circulation |volume=58 |issue=2 |pages=273–9 |year=1978 |pmid=668075 |doi= 10.1161/01.cir.58.2.273|url=}}
19. ^{{cite journal |author=Hoit BD |title=Medical treatment of valvular heart disease |journal=Curr. Opin. Cardiol. |volume=6 |issue=2 |pages=207–11 |year=1991 |pmid=10149580 |doi= 10.1097/00001573-199104000-00005|url=}}

Effectiveness