机械人工心脏瓣膜(MPHV)通常用于预期寿命长的瓣膜性心脏病患者。关于MPHV患者住院特定原因的纵向数据很少。我们调查了MPHV患者全因住院和死亡的风险。我们进行了一项前瞻性观察性持续研究,其中包括MPHV连续患者,这些患者参考罗马PoliclinicoUmbertoI的动脉粥样硬化血栓形成门诊诊所进行维生素K拮抗剂(VKA)管理。研究终点是全因,心血管住院和总死亡率。我们纳入了305例MPHV患者(38.4%的女性,中位年龄60.2岁)。53.5%的MPHV部位为主动脉,二尖瓣占29.5%,主动脉占17%。在57.3个月的中位随访中,142例住院(8.16/100人年)。住院最常见的原因是心血管疾病(每100人年3.62),感染,手术和出血。心血管住院的预测因素是心房颤动(危险比[HR]1.75,95%置信区间[95CI]1.04-2.95,p=0.035),既往卒中/短暂性脑缺血发作(HR2.96,95CI1.59-5.48,p=0.001)和外周动脉疾病(HR2.42,95CI1.09-5.36,p=0.030).在97.2个月的中位随访期间,61例死亡(每100人年2.43例)。年龄与死亡风险直接相关(HR1.088,95CI1.054-1.122,p<0.001),而高于中位数的治疗时间呈负相关(HR0.436,95CI0.242-0.786,p=0.006).总之,MPHV患者的住院率很高,尤其是与心血管有关的.死亡率很高,但它可能会减少通过保持良好的抗凝质量。
Mechanical prosthetic heart valves (MPHV) are commonly used for valvular heart disease in patients with long life expectancy. Few longitudinal data on hospitalizations specific causes in MPHV patients are available. We investigated the risk of all-cause hospitalization and mortality in MPHV patients. We performed a prospective observational ongoing study including MPHVs consecutive patients referring to the atherothrombosis outpatient clinic of the Policlinico Umberto I of Rome for the vitamin K antagonist (VKA) management. Study endpoints were all-cause, cardiovascular hospitalization and overall mortality. We included 305 MPHV patients (38.4% women, median age 60.2 years). The site of MPHV was aortic in 53.5%, mitral in 29.5% and mitro-aortic in 17%. During a median follow-up of 57.3 months, 142 hospitalizations occurred (8.16 per 100 person-years). The most common causes of hospitalization were cardiovascular disease (3.62 per 100 person-years), infections, surgery and bleeding. Predictors of cardiovascular hospitalization were atrial fibrillation (Hazard ratio [HR] 1.75, 95% confidence interval [95%CI] 1.04-2.95, p= 0.035), previous stroke/transient ischemic attack (HR 2.96, 95%CI 1.59-5.48, p=0.001) and peripheral artery disease (HR 2.42, 95%CI 1.09-5.36, p=0.030). During a median follow-up of 97.2 months, 61 deaths occurred (2.43 per 100 person-years). Age was directly associated with the risk of death (HR 1.088, 95%CI 1.054-1.122, p<0.001), while time in therapeutic range above the median was inversely associated (HR 0.436, 95%CI 0.242-0.786, p= 0.006). In conclusion, MPHV patients had a high incidence of hospitalizations, especially cardiovascular-related. The incidence of death is high, but it may be reduced by maintaining a good quality of anticoagulation.