2022年 · 第38卷第03期

Heart valve disease is a common disease. With the aging of China's population, the number of patients with valve disease has further increased. According to the characteristics of patients with heart valve diseases in China, it is imperative to standardize the treatment of valve surgery in China and improve the technique of valve surgery.

Heart valve disease is a common and frequently-occurring disease in Chinese people. With the intensification of aging, the number of potential patients with valve disease will further increase. Valve surgery is the main means of treating heart valve diseases. There are about 80,000 valve surgeries in China every year, accounting for about 30% of the total cardiovascular surgery; Although interventional therapy is developing rapidly, surgical treatment is still the mainstream of valve treatment at present. Therefore, it is the requirement of today's era to standardize valve surgical treatment and improve valve surgical technology in China.

The incidence of rheumatic valvular disease in China ranks second in the world, and there is still a large patient base and a certain incidence rate^[1,2]。 Rheumatic mitral valve disease is also one of the main causes of heart valve disease in China, and it is a major disease affecting the health of Chinese people^[3]。 The incidence of rheumatic mitral valve disease in developed countries in Europe and America is very rare, and the literature on the diagnosis and treatment of rheumatic mitral valve quoted in the valve disease guidelines is generally older, especially the recommendation for the treatment of rheumatic mitral stenosis is balloon dilatation^[4]It does not reflect the technical development of rheumatic valve surgery and adapt to the reality of our country. In the past 20 years, experts from many Asian countries, including my country, have made great achievements in the lean treatment of rheumatic mitral valve surgery^[5,6,7,8]。 In order to promote technological development, Chinese experts have completed the 2018 edition of the Expert Consensus on Surgical Treatment Indications for Rheumatic Mitral Valve Disease in China based on years of research results and experience in this field^[9]。 In recent years, rheumatic mitral valve repair surgery has been carried out in many centers in China, and the number of surgical cases has increased year by year. Articles on related surgical techniques, medium-and long-term follow-up results and comparative research with other treatment methods have also been published one after another^[10,11,12]。 In view of this, many domestic experts in the field of heart valve disease jointly discussed and deeply discussed, and finally formed a new Chinese expert consensus on the surgical treatment of rheumatic mitral valve disease. This consensus was published in the 2018 edition of the Consensus.^[9]Based on this, refer to the 2020 ACC/AHA Valve Guidelines^[4]Combined with the latest research results to improve. It provides a reference for the surgical treatment of rheumatic mitral valve disease and helps clinicians make medical decisions. However, in clinical practice, doctors should make individualized diagnosis and treatment plans according to the patient's condition. In addition, some of the treatment indications put forward in the consensus are not supported by sufficient evidence-based medical evidence. In the future, the expert group will regularly update and improve the content of the consensus.

The successful application of prosthetic valve replacement has greatly improved the long-term prognosis of patients with heart valve disease. At present, about 280,000 heart valve replacement operations are performed every year worldwide, and about 60,000 heart valve operations are performed every year in China^[1]Although the mechanical valves or biological valves used have made significant progress, the artificial heart valves used in clinical practice are not perfect and ideal. After valve replacement, patients may change from the torment of their own valve disease to the trouble of implanting artificial valves. Therefore, it is of great significance to personalize the selection of prosthetic valves that are more suitable for patients through comprehensive consideration of the patient's individual condition. Combined with the specific situation in our country, this paper fully discusses and forms the consensus of Chinese experts, so as to further promote the personalized and rational selection and application of prosthetic valves in heart valve surgery in China.

The normal function of mitral valve depends on the cooperation of leaflets, chordae tendineae, papillary muscle, annulus, left ventricle and other parts, and any change in the structure or function of any of these parts can cause mitral regurgitation (MR). According to the etiology, mitral insufficiency can be divided into primary (organic) and secondary (functional). The definition of secondary mitral insufficiency in most literature is equivalent to functional mitral regurgitation (FMR). Primary mitral insufficiency is caused by organic lesions such as leaflets and chordae tendineae; Mitral insufficiency caused by enlargement of the left ventricle (left atrium), enlargement of the annulus, and dysfunction of papillary muscle is called FMR.

Valvular heart disease is still one of the most common heart diseases in China. According to the statistics of China's cardiopulmonary bypass data in 2019, the number of heart valve surgeries in China has maintained a continuous growth trend, with 73,000 operations per year, accounting for about 30% of all heart surgeries^[1]。 The treatment methods of heart valve disease mainly include prosthetic valve replacement and valvuloplasty repair. Mechanical valves have been used clinically since 1950s, and are favored by many patients because of their good durability; At the same time, combined with the disease spectrum characteristics of valvular heart disease in China (middle-aged rheumatic valvular heart disease accounts for a high proportion), mechanical valve has always been the main type of replacement valve, but due to the lifelong use of anticoagulants, mechanical valve replacement is bound to bring complications related to thromboembolism and bleeding. At present, with the change of the characteristics of heart valve diseases in China (the proportion of rheumatic valve disease is decreasing, while the degenerative valve disease in the elderly is increasing), the change of life concept and the rise of interventional valves, the frequency and proportion of biological valve use are increasing year by year, but there is still a certain risk of thromboembolism in the early stage after biological valve replacement^[2]。 Therefore, standardized anticoagulation therapy after heart valve surgery is particularly important, which can not only effectively prevent the risk of thromboembolism and reduce anticoagulation-related bleeding complications, but also be a key factor in improving long-term survival and quality of life.

infective endocarditis (IE) is an inflammation of the heart valves and/or the heart lining caused by infection with bacteria, fungi, or other pathogenic microorganisms (viruses, chlamydia, etc.). The annual incidence rate of the American population is about 15 per 100,000, and it has increased in recent years^[1]； The annual incidence rate of the European population is 3~10/100,000, among which the annual incidence rate of the elderly aged 70~80 is 14.5/100,000^[2]。 With the aging of the population in China, the proportion of elderly patients with degenerative valvular heart disease is increasing, and the incidence of IE is increasing obviously with the increase of intracardiac implants and endovascular examinations. However, there is no definite epidemiological data^[3]。