妊娠与人工心脏瓣膜:导航风险,抗凝血和瓣膜功能在不断增长的人口。

IF 1 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ishani Joshi, Jonathan Buber
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引用次数: 0

摘要

植入人工心脏瓣膜的妊娠患者面临复杂的挑战,需要多学科的护理和个性化的决策。虽然育龄妇女通常首选生物瓣膜,以避免抗凝相关的胎儿风险,但这些瓣膜容易发生结构退化,可能会因怀孕的生理需求而加速。相反,机械瓣膜提供耐用性,但必须终身抗凝,造成瓣膜血栓形成、胎儿出血和华法林胚胎病的重大风险。罗斯手术可以用于晚期主动脉瓣疾病患者,这是一个很有吸引力的选择,但只在高度专业化的中心提供。在这篇综述中,我们介绍了关于机械和生物人工心脏瓣膜孕妇的母胎结局、瓣膜功能和抗凝策略的最新数据。我们强调了关于瓣膜使用类型、妊娠期最佳抗凝、现代瓣膜设计的耐用性和长期再手术风险的地理和知识差距。未来的研究重点包括统一的全球方法,改善低收入和中等收入国家获得现代外科和医疗解决方案的机会,直接口服抗凝剂的安全性,改善妊娠期间瓣膜功能的监测,以及生物人工瓣膜模型的比较研究。通过整合不断发展的证据,我们的目标是支持这一高危患者群体的知情决策和多学科管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pregnancy with prosthetic heart valves: navigating risks, anticoagulation, and valve function in a growing population.

Pregnancy in patients with prosthetic heart valves presents complex challenges requiring multidisciplinary care and individualized decision-making. While bioprosthetic valves are often preferred in women of childbearing age to avoid anticoagulation-related fetal risks, these valves are susceptible to structural degeneration potentially accelerated by the physiologic demands of pregnancy. Conversely, mechanical valves offer durability but necessitate lifelong anticoagulation, posing substantial risks of valve thrombosis, fetal hemorrhage, and warfarin embryopathy. The Ross operation, which can be considered for individuals with advanced aortic valve disease, is an appealing option yet is offered only in highly specialized centers. In this review, we present contemporary data on maternal and fetal outcomes, valve function, and anticoagulation strategies in pregnant patients with mechanical and bioprosthetic heart valves. We highlight geographical and knowledge gaps regarding type of valve utilization, optimal anticoagulation in pregnancy, durability of modern valve designs, and long-term reoperation risk. Future research priorities include uniform global approach with improved access to contemporary surgical and medical solutions in low- and middle-income countries, safety of direct oral anticoagulants, improved surveillance of valve function during pregnancy, and comparative studies of bioprosthetic valve models. By consolidating evolving evidence, we aim to support informed decision-making and multidisciplinary management for this high-risk patient population.

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来源期刊
Future cardiology
Future cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.80
自引率
5.90%
发文量
87
期刊介绍: Research advances have contributed to improved outcomes across all specialties, but the rate of advancement in cardiology has been exceptional. Concurrently, the population of patients with cardiac conditions continues to grow and greater public awareness has increased patients" expectations of new drugs and devices. Future Cardiology (ISSN 1479-6678) reflects this new era of cardiology and highlights the new molecular approach to advancing cardiovascular therapy. Coverage will also reflect the major technological advances in bioengineering in cardiology in terms of advanced and robust devices, miniaturization, imaging, system modeling and information management issues.
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