PDF(Pubmed)
Abstract：
BACKGROUND: The choice of an artificial mitral valve (MV) is a crucial clinical decision that affects the long-term survival and quality of life of patients. However, current guidelines recommend selecting MV based on patient age and life expectancy at the time of mitral valve replacement (MVR), without considering the etiology of MV disease. This study aimed to investigate whether MV disease etiology should be considered when choosing a valve for MVR and to evaluate the impact of MV disease etiology on long-term patient survival.
METHODS: Using data (2002-2018) from Taiwan\'s National Health Insurance Research Database, the authors conducted a nationwide retrospective cohort study to compare the biological and mechanical valves in terms of all-cause mortality as the primary outcome. The inverse probability of the treatment weighting method was used to reduce the effects of the confounding factors. The following etiologies were assessed: infective endocarditis, rheumatic heart disease, ischemic mitral regurgitation, and degenerative mitral regurgitation.
RESULTS: In patients aged below 70 years, it was observed that mechanical valves demonstrated an association with benefits compared to biological valves in the context of survival. In patients with infective endocarditis aged below 72 years, mechanical valves were associated with survival benefits, but not in those with stroke during hospitalization. These valves were also found to be linked with survival advantages for patients with rheumatic heart disease aged below 60 years and for those with degenerative mitral regurgitation aged below 72 years. However, no age-dependent effects of valve type on all-cause mortality were observed in patients with ischemic mitral regurgitation.
CONCLUSIONS: The etiology of MV disease appears to be important in the selection of a suitable MV and determination of a cutoff age for mechanical and biological MVR.
METHODS: Using data (2002-2018) from Taiwan\'s National Health Insurance Research Database, the authors conducted a nationwide retrospective cohort study to compare the biological and mechanical valves in terms of all-cause mortality as the primary outcome. The inverse probability of the treatment weighting method was used to reduce the effects of the confounding factors. The following etiologies were assessed: infective endocarditis, rheumatic heart disease, ischemic mitral regurgitation, and degenerative mitral regurgitation.
RESULTS: In patients aged below 70 years, it was observed that mechanical valves demonstrated an association with benefits compared to biological valves in the context of survival. In patients with infective endocarditis aged below 72 years, mechanical valves were associated with survival benefits, but not in those with stroke during hospitalization. These valves were also found to be linked with survival advantages for patients with rheumatic heart disease aged below 60 years and for those with degenerative mitral regurgitation aged below 72 years. However, no age-dependent effects of valve type on all-cause mortality were observed in patients with ischemic mitral regurgitation.
CONCLUSIONS: The etiology of MV disease appears to be important in the selection of a suitable MV and determination of a cutoff age for mechanical and biological MVR.
摘要：
背景：人工二尖瓣（MV）的选择是影响患者长期生存和生活质量的关键临床决定。然而,当前指南建议根据患者年龄和MV置换（MVR）时的预期寿命选择MV，不考虑MV病的病因。本研究旨在调查选择MVR瓣膜时是否应考虑MV疾病的病因，并评估MV疾病病因对患者长期生存的影响。
方法：使用台湾国民健康保险研究数据库（2002年至2018年）的数据，我们进行了一项全国范围的回顾性队列研究,比较了生物瓣膜和机械瓣膜作为主要结局的全因死亡率.治疗加权方法的逆概率用于减少混杂因素的影响。评估了以下病因：感染性心内膜炎（IE），风湿性心脏病（RHD），缺血性二尖瓣返流(IMR),和退行性二尖瓣反流（DMR）。
结果：在<70岁的患者中，据观察,在生存的背景下,与生物瓣膜相比,机械瓣膜与获益相关.在年龄<72岁的IE患者中，机械瓣膜与生存获益相关，但住院期间中风的患者却没有。还发现这些瓣膜与年龄<60岁的RHD患者和年龄<72岁的DMR患者的生存优势有关。然而,在IMR患者中,未观察到瓣膜类型对全因死亡率的年龄依赖性影响.
结论：MV疾病的病因在选择合适的MV和确定机械和生物MVR的截止年龄方面似乎很重要。
方法：使用台湾国民健康保险研究数据库（2002年至2018年）的数据，我们进行了一项全国范围的回顾性队列研究,比较了生物瓣膜和机械瓣膜作为主要结局的全因死亡率.治疗加权方法的逆概率用于减少混杂因素的影响。评估了以下病因：感染性心内膜炎（IE），风湿性心脏病（RHD），缺血性二尖瓣返流(IMR),和退行性二尖瓣反流（DMR）。
结果：在<70岁的患者中，据观察,在生存的背景下,与生物瓣膜相比,机械瓣膜与获益相关.在年龄<72岁的IE患者中，机械瓣膜与生存获益相关，但住院期间中风的患者却没有。还发现这些瓣膜与年龄<60岁的RHD患者和年龄<72岁的DMR患者的生存优势有关。然而,在IMR患者中,未观察到瓣膜类型对全因死亡率的年龄依赖性影响.
结论：MV疾病的病因在选择合适的MV和确定机械和生物MVR的截止年龄方面似乎很重要。
