Evolution à moyen terme et rôle de l'échocardiographie après remplacement valvulaire

Abstract

SummaryAims: The aim of the study was to evaluate the rate of occurrence of complications associated with prosthetic valves (PV) in ambulatory practice and to further evaluate the usefulness of echocardiography in the diagnosis and follow-up of these complications. Method: The study included 226 patients with a mean age of 57.7 ± 14.7 years in whom 253 PV (209 mechanical and 44 biological) were implanted. Immediate post-operative echocardiography was performed followed by annual echographic control studies. Results: Mean follow-up was 6.8 ± 3.8 years, corresponding to 1526 patient years. Complication-free patients numbered 72.7 ± 3.5% in the presence of mechanical prosthetic valves (MV) and 68.6 ± 8.1% in the presence of biological valves (BV) (p = 0.55). With respect to positions, complication-free patients numbered 68.3 ± 4.0%, 85.3 ± 4.8% and 51.9 ± 15% with PV in the aortic, mitral and mitro-aortic positions respectively (p = 0.54). The haemorrhagic and endocarditic risk was most important in the presence of a MV. All cases of PV degeneration occurred in patients with a BV in the mitral position. There was a tendency towards an increased incidence of paravalvalvular leaks and re-interventions in the presence of BV and a tendency towards an increased incidence of thrombo-embolic complications with PV in the aortic position. A PV linked complication was detected on average every 24.4 echocardiographs. Conclusion: The incidence of PV linked complications is low with a majority of patients free of any complications following valve replacement. The type and position of the PV only appears to influence the incidence of haemorrhages, degenerescence, re-intervention and endocarditis. The usefulness of routine echocardiographic follow-up therefore seems limited. An echocardiographic follow-up is, however, justified in certain settings, namely in the presence of para-valvular leaks, increased trans-valvular gradients, un- 237Travail original Kardiovaskuläre Medizin 2007;10: Nr 7-8 liées à la présence d'une PV est faible et la majorité des patients ne présente aucune complication suite au remplacement valvulaire. Le type et la localisation de la PV n'influence que l'incidence des hémorragies, des dégénéres-cences, des ré-interventions et des endocardites. L'apport d'un suivi échocardiographique de routine est faible. Un suivi échocardiogra-phique est cependant justifié en présence d'une fuite paravalvulaire, d'un gradient transvalvulaire élevé, d'une évolution clinique défavorable ou d'une PB âgée de plusieurs années.