文献简介

出版社:

作  者:N. Mabvuure et al

编  号:10.1093/icvts/ivs212

关键字:Tricuspid valve • Biological valve • Thoracic surgery • Tricuspid valve replacement • Carcinoid syndrome

年  份:2012   点击量:529

文献摘要

Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘In patients with carcinoid syndrome undergoing valve replacement, will a biological valve have acceptable durability?’ Altogether, more than 130 papers were found using the reported search, of which 17 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The pooled data from all papers represent 51 patients with carcinoid right heart disease who underwent tricuspid valve replacement. Two ‘outcomes’ studies reported a 30-day postoperative mortality of 16.7–18% and 2-year survival rates of 44 and 50%, respectively. Seventeen patients were detailed in case reports. Of these 17 patients, 7 died during the follow-up period. All but one of these patients had a normal bioprosthesis at echocardiography or at post-mortem. One patient with a plaque-covered valve had a functionally normal valve. We conclude that at present, the best available evidence suggests that although 30-day mortality approaches 20%, approximately half of patients with carcinoid syndrome undergoing tricuspid valve replacement can be expected to survive 2 years. Some patients survive considerably longer than this, beyond 10 years in some cases. Importantly, at autopsy, many replacement valves have been shown to be normal, with a few patients reported as having died of cardiac causes. This should be taken as cautious evidence that biological valves have an acceptable lifespan in patients with carcinoid syndrome and that the process of valve destruction seen in carcinoid patients does not continue to a significant level in the bioprosthesis. Caveats to this include the lack of any directly comparative trial and the predominance of case reports as opposed to higher-level evidence.
摘要
根据外科手术的框架协议,我们讲述了一个最好的证据话题。本文提出的问题是:“类癌综合征患者接受心脏瓣膜置换手术,该生物瓣膜能否具有较好的耐久性呢?”搜索发现130多篇论文的使用报告,其中17篇代表了临床问题的最佳回答。从作者、期刊、日期、出版国、病例组研究、研究的类型、论文的相关结果和结果列表,汇集了具有代表的51例类癌性心脏病患者进行三尖瓣置换手术的数据。两个结果的研究报告指出,三尖瓣置换手术术后30天死亡率为16.7%和18%,2年的生存率分别为44%和50%,该报道有17例详细的病例报告,在这17例患者中,7位患者在随访期间死亡。所有的死亡患者在超声心动图检查或验尸时,发现只有一个患者有正常的生物假体,还有一名患者的斑块覆盖阀有一个功能正常的瓣膜。根据目前的证据我们得出这样的结论:虽然术后30天的死亡率接近20%,但是类癌综合征患者接受三尖瓣置换术能存活2年的病人约占一半,有些患者能存活相当长时间,有些患者超过10年。更重要的是,尸检发现很多更换的瓣膜都是正常的,但有少数患者为心脏原因死亡。类癌综合征患者的生物瓣膜有一个接受的使用寿命,我们看到破坏类癌患者瓣膜的过程在生物发展中将不再继续发生。但是我们要谨慎采用这些证据,因为这些证据缺乏任何直接的比较试验和病例报告,不是更高水平的证据。