目的:对于75岁或以下的患者,隔离二尖瓣置换术(MVR)中的假体选择仍存在争议,因为大多数比较假体类型的研究都包括大量的联合手术,并且受益受伴随手术的影响。这项研究比较了不同年龄段的倾向匹配人群中孤立的机械和生物假体二尖瓣的长期结果。
方法:这是一个回顾性研究,多中心,倾向匹配观察性研究。基线特征,操作细节,并收集长期结局(死亡率和手术/经导管再介入的自由度).
结果:1536个孤立的二尖瓣置换术(806个机械,在2000年至2017年之间进行了730种生物假体)。超过90%的合格患者成功进行了倾向匹配,在年龄<65岁的患者中,机械瓣膜和生物瓣膜各226个,在年龄65~75岁的患者中,生物瓣膜和机械瓣膜各171个,中位随访时间为13年(最长20年).在<65岁的匹配患者中,机械瓣膜的10年生存率优于生物瓣膜(78.2%vs69.8%,p=0.029),十年的再干预自由度也是如此(96.2%和81.3%,p<0.001)。对于65-75岁的匹配患者,在10年生存率中,机械瓣膜和生物瓣膜之间没有差异(64.6%vs60.8%,p=0.86)或10年无再干预(94.0%对97.2%,p=0.23)。术后中风率,消化道出血,肾功能衰竭,和永久性起搏器插入相似。
结论:在需要隔离MVR的患者中,对于<65岁的患者,机械瓣膜可显著改善长期生存率,避免再干预,而与生物人工瓣膜相比,在65-75岁时没有观察到益处。
OBJECTIVE: Prothesis choice in isolated mitral valve replacement for patients aged 75 years or younger remains debated as most studies comparing prothesis type have included large proportions of combined operations and benefits are influenced by concomitant procedures. This study compared long-term outcomes of isolated mechanical versus bioprosthetic mitral valves in different age groups of propensity-matched populations.
METHODS: This is a retrospective, multicentre, propensity-matched observational study. Baseline characteristics, operative details and long-term outcomes (mortality and freedom from surgical/transcatheter reintervention) were collected.
RESULTS: Totally, 1536 isolated mitral valve replacements (806 mechanical, 730 bioprosthetic) were performed between 2000 and 2017. Over 90% of eligible patients successfully underwent propensity matching, yielding 226 each of mechanical and bioprosthetic valves in patients aged <65 years and 171 each of bioprosthetic and mechanical valves in patients aged 65-75 years with median follow-up of 13 years (maximum 20 years). In matched patients <65 years, 10-year survival was superior with mechanical valves versus bioprosthetic valves (78.2% vs 69.8%, P = 0.029), as was 10-year freedom from reintervention (96.2% vs 81.3%, P < 0.001). For matched patients between 65 and 75 years, there were no differences between mechanical and bioprosthetic valves in 10-year survival (64.6% vs 60.8%, P = 0.86) or 10-year freedom from reintervention (94.0% vs 97.2%, P = 0.23). Rates of post-operative stroke, gastrointestinal bleeding, renal failure and permanent pacemaker insertion were similar.
CONCLUSIONS: In patients requiring isolated mitral valve replacement, mechanical valves confer significantly better long-term survival and freedom from reintervention for patients <65 years, while no benefit is observed at age 65-75 years compared to bioprosthetic valves.