Abstract：
Recommendations for prosthesis type in older patients who underwent surgical aortic valve replacement (SAVR) are established, albeit undervalidated. The purpose of this study is to compare outcomes after bioprosthetic versus mechanical SAVR across various age groups. This was a retrospective study using an institutional SAVR database. All patients who underwent isolated SAVR were compared across valve types and age strata (<65 years, 65 to 75 years, >75 years). Patients who underwent concomitant operations, aortic root interventions, or previous aortic valve replacement were excluded. Objective survival and aortic valve reinterventions were compared. Kaplan-Meier survival estimation and multivariate regression were performed. A total of 1,847 patients underwent SAVR from 2010 to 2023. A total of 1,452 patients (78.6%) received bioprosthetic valves, whereas 395 (21.4%) received mechanical valves. Of those who received bioprosthetic valves, 349 (24.0%) were aged <65 years, 627 (43.2%) were 65 to 75 years, and 476 (32.8%%) were older than 75 years. For patients who received mechanical valves, 308 (78.0%) were aged <65 years, 84 (21.3%) were between 65 and 75 years, and 3 (0.7%) were >75 years. The median follow-up in the total cohort was 6.2 (2.6 to 8.9) years. No statistically significant differences were observed in early-term Kaplan-Meier survival estimates between SAVR valve types in all age groups. However, the cumulative incidence estimates of aortic valve reintervention were significantly higher in patients aged under 65 years who received bioprosthetic than those who received mechanical valves, with 5-year reintervention rates of 5.8% and 3.1%, respectively (p = 0.002). On competing risk analysis for valve reintervention, bioprosthetic valves were significantly associated with an increased hazard of aortic valve reintervention (hazard ratio 3.35, 95% confidence interval 1.73 to 6.49, p <0.001). In conclusion, SAVR with bioprosthetic valves (particularly, in patients aged <65 years) was comparable in survival to mechanical valve SAVR but significantly associated with increased valve reintervention rates.
摘要：
建立了接受外科主动脉瓣置换术（SAVR）的老年患者的假体类型建议，尽管验证不足。这项研究的目的是比较不同年龄段的生物假体与机械SAVR后的结果。这是一项使用机构SAVR数据库的回顾性研究。所有接受孤立SAVR的患者在瓣膜类型和年龄层次(<65岁,65-75岁,>75岁）。同时接受手术的患者，主动脉根干预，或之前的主动脉瓣置换术被排除.目的生存和主动脉瓣再干预进行比较。进行Kaplan-Meier生存估计和多变量回归。从2010年至2023年，共有1,847名患者接受了SAVR。1,452例（78.6％）患者接受了生物人工瓣膜，而395例（21.4％）接受了机械瓣膜。在那些接受生物人工瓣膜的人中，349人(24.0%)<65岁，627人（43.2%）65-75岁，年龄超过75岁的有476人(32.8%)。对于机械瓣膜患者，308（78.0％）<65岁，84岁(21.3%)在65-75岁之间，3例(0.7%)>75岁。总队列的中位随访时间为6.2[2.6-8.9]年。在所有年龄组中，SAVR瓣膜类型之间的早期Kaplan-Meier生存估计没有观察到统计学上的显着差异。然而,主动脉瓣再介入的累积发生率估计值在接受生物瓣膜和机械瓣膜的65岁以下患者中显著较高,5年再干预率为5.8%和3.1%，分别(p=0.002)。关于阀门再干预的竞争性风险分析，生物人工瓣膜与房室再干预风险增加显著相关(HR，3.35；95%CI，1.73-6.49；p<0.001)。总之,使用生物瓣膜的SAVR（特别是在<65岁的患者中）在生存率方面与机械瓣膜SAVR相当，但与瓣膜再干预率增加显着相关。
