目的:对于50-70岁患者的最佳二尖瓣置换(MVR)选择仍存在争议。这项研究的目的是回顾性比较该患者人群中机械和生物假体MVR的长期结果。
方法:回顾性分析2004-2018年接受MVR患者的数据。主要结果是全因死亡率。次要结果包括围手术期和晚期发病率。
结果:286名年龄在50-70岁的倾向匹配患者(n=143机械;n=143生物假体)被纳入最终分析。最长随访时间为15.8年。在30天时,各组之间的全因死亡率没有显着差异,1年,5年,10年,在最长的随访中。接受机械MVR的患者术后房颤发生率明显较低(p=0.001)。败血症的发生率没有显着差异,急性肾损伤,浅层和深部胸骨伤口感染,纵隔出血,和永久性起搏器植入。在最长的随访中,心肌梗死没有差异,中风,心力衰竭,或整体再住院。同时,接受生物人工瓣膜的患者的MVR比率增加(p=0.015).
结论:在50-70岁的患者中,机械和生物假体MVR后的生存率与15年的随访相似。生物假体MVR与重复MVR的风险增加有关。机械MVR与卒中风险增加无关。在该患者人群中选择瓣膜需要认真考虑结构性瓣膜恶化和随后的再次手术风险以及出血和血栓栓塞风险。
OBJECTIVE: There remains debate over the optimal mitral valve replacement (MVR) option for patients aged 50-70 years. The objective of this study was to retrospectively compare the long-term outcomes of
mechanical and bioprosthetic MVR in this patient population.
METHODS: Data from patients undergoing MVR between 2004 and 2018 were retrospectively reviewed. The primary outcome was all-cause mortality. Secondary outcomes included perioperative and late morbidity.
RESULTS: Two hundred and eight-six propensity-matched patients (n = 143
mechanical; n = 143 bioprosthetic) aged 50-70 years were included in the final analysis. Maximum follow-up was 15.8 years. There was no significant difference in all-cause mortality between the groups at 30 days, 1 year, 5 years, 10 years, and at the longest follow-up. Patients who underwent
mechanical MVR experienced significantly lower rates of postoperative atrial fibrillation (P = 0.001). There were no significant differences in rates of sepsis, acute kidney injury, superficial and deep sternal wound infection, mediastinal bleeding, and permanent pacemaker implantation. At the longest follow-up, there were no differences in myocardial infarction, stroke, heart failure or overall rehospitalization. At the same time point, there was an increased rate of MVR in patients receiving a bioprosthetic valve (P = 0.015).
CONCLUSIONS: Survival following
mechanical and bioprosthetic MVR in patients 50-70 years of age is similar to up to 15 years of follow-up. Bioprosthetic MVR is associated with an increased risk of repeat MVR.
Mechanical MVR is not associated with an increased risk of stroke. Valve selection in this patient population requires diligent consideration of structural valve deterioration and subsequent reoperation risk as well as bleeding and thromboembolic risk.