Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years.
Bioprosthetic vs mechanical mitral valve replacement for infective endocarditis in patients aged 50 to 69 years.
复制标题
生物瓣膜与机械二尖瓣置换术治疗 50 至 69 岁患者感染性心内膜炎的比较
DOI：
10.1002/clc.23407
复制
发表时间：
2020-10
影响因子：
2.7
通讯作者：
Wang Y
中科院分区：
文献类型：
--
作者：
Hu X;Jiang W;Xie M;Guo R;Yim WY;Dong N;Wang Y
感染性心内膜炎（IE）二尖瓣置换术（MVR）中人工瓣膜的最佳选择存在争议和挑战，特别是对于年轻患者。50 ~ 69岁IE患者机械和生物MVR的术后结局不同。回顾性分析了2002年至2018年湖北省医院所有50至69岁的原发性MVR IE患者。中位随访时间为8.7年（IQR，6.8 - 10.9年）。使用倾向评分匹配（1：3比例）获得了492例生物瓣膜组和机械人工瓣膜组之间具有可比基线特征的患者。结局为术后中长期生存率、二尖瓣再次手术、人工瓣膜心内膜炎（PVE）、卒中和大出血事件。机械瓣膜组和生物瓣膜组MVR后15年生存率分别为80.6%和69.3%（HR 0.545，P = 0.040）。机械瓣膜二尖瓣再手术的累积发生率为8.8%，生物瓣膜为21.4%（HR 0.260，P = .002）。机械瓣膜和生物瓣膜的PVE累积发生率分别为5.6%和7.2%（HR 0.629，P = 0.435）。机械瓣膜和生物瓣膜的卒中累积发生率分别为12.9%和10.5%（HR 1.217，P = 0.647）。机械瓣膜和生物瓣膜的大出血累积发生率分别为12.0%和6.75%（HR 1.579，P = 0.268）。在年龄50 - 69岁的IE患者中，与生物瓣膜相比，机械瓣膜假体在MVR后15年内具有更好的生存率和更低的再手术率。这些发现表明，在该患者组中，机械瓣膜可能是生物瓣膜的更合理替代方案。
The optimal choice of the valve prosthesis in mitral valve replacement (MVR) for infective endocarditis (IE) is controversial and challenging, particularly for younger patients. The postoperative outcomes of mechanical and biological MVR in IE patients aged 50 to 69 years are different. All IE patients aged 50 to 69 years with primary MVR in Hubei province hospitals from 2002 to 2018 were retrospectively reviewed. The median duration of follow‐up was 8.7 years (IQR, 6.8‐10.9 years). Propensity score matching (1:3 ratio) was used to yield 492 patients with comparable baseline features between bioprostheses and mechanical prosthetic valve groups. Outcomes were postoperative mid‐ to long‐ term survival, mitral valve reoperation, prosthetic valve endocarditis (PVE), stroke, and major bleeding events. Fifteen‐year survival after MVR was 80.6% in the mechanical valve group and 69.3% in the bioprostheses group (HR 0.545, P = .040). The cumulative incidence of mitral valve reoperation was 8.8% with mechanical valves and 21.4% with bioprostheses (HR 0.260, P = .002). The cumulative incidence of PVE was 5.6% with mechanical valves and 7.2% with bioprostheses (HR 0.629, P = .435). The cumulative incidence of stroke was 12.9% with mechanical valves and 10.5% with bioprostheses (HR 1.217, P = .647). The cumulative incidence of major bleeding was 12.0% with mechanical valves and 6.75% with bioprostheses (HR 1.579, P = .268). Mechanical valve prostheses were associated with better survival, lower rates of reoperation compared with bioprostheses within 15 years after MVR in IE patients aged 50 to 69. These findings suggest mechanical valve prostheses may be a more reasonable alternative to bioprostheses in this patient group.
登录
查看更多内容
影响因子：
37.8
作者：
D'Agostino, Ralph B., Jr.
通讯作者：
D'Agostino, Ralph B., Jr.
影响因子：
4.6
作者：
Manne, Mahesh B.;Shrestha, Nabin K.;Fraser, Thomas G.
通讯作者：
Fraser, Thomas G.
影响因子：
4.6
作者：
Toyoda, Nana;Itagaki, Shinobu;Sundt, Thoralf M.
通讯作者：
Sundt, Thoralf M.
DOI：
10.1016/j.jtcvs.2017.07.077
发表时间：
2017-12-01
影响因子：
6
作者：
Toyoda, Nana;Itagaki, Shinobu;Chikwe, Joanna
通讯作者：
Chikwe, Joanna
影响因子：
3.1
作者：
Krajinovic, Vladimir;Ivancic, Stipe;Barsic, Bruno
通讯作者：
Barsic, Bruno