Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age
Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age
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DOI：
10.1161/circulationaha.106.681429
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发表时间：
2007-09-11
期刊：
影响因子：
37.8
通讯作者：
Mesana, Thierry G.
中科院分区：
文献类型：
--
作者：
Ruel, Marc;Chan, Vincent;Mesana, Thierry G.
背景-一些中心倾向于用组织而不是机械瓣膜替换病变的自体心脏瓣膜，即使是在年轻的成年患者中。然而，缺乏支持这一方法的长期数据。我们研究了生存的影响，选择一个组织与机械假体在初始的左心瓣膜置换术在一个队列的成年人< 60岁的人随访超过20 years.Methods和Results-Comorbid和程序的数据，可从6554例在我们的机构在过去的35年接受瓣膜置换术。其中，1512例患者提供了超过20年的随访数据，其中567例为首次左心瓣膜手术时年龄< 60岁的成年人（平均存活随访时间，24.0 +/- 3.1年）。晚期结局采用考克斯回归分析。组织主动脉瓣和二尖瓣置换术后20年，瓣膜再次手术（通常用于不再市售的假体）分别发生在89%和84%的患者中，死亡率为4.3%。初次主动脉瓣置换术时植入组织与机械假体的患者之间的生存率无差异（风险比0.95; 95% CI：0.7，1.3; P = 0.7）。对于二尖瓣置换术患者，长期生存率低于主动脉瓣置换术后（风险比1.4; 95% CI：1.1，1.8; P = 0.003），但同样，使用组织假体与使用机械假体相比，无有害影响结论：根据我们的经验，在年轻人初次手术时选择组织假体不会对随访到第三个十年的生存率产生负面影响，尽管存在再次手术的风险。
Background - Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults < 60 years of age who were followed for over 20 years.Methods and Results - Comorbid and procedural data were available from 6554 patients who underwent valve replacement at our institution over the last 35 years. Of these, 1512 patients contributed follow-up data beyond 20 years, of whom 567 were adults < 60 years of age at first left-heart valve operation (mean survivor follow-up, 24.0 +/- 3.1 years). Late outcomes were examined with Cox regression. Valve reoperation, often for prostheses that are no longer commercially available, occurred in 89% and 84% of patients by 20 years after tissue aortic and mitral valve replacement, respectively, and was associated with a mortality of 4.3%. There was no survival difference between patients implanted with a tissue versus a mechanical prosthesis at initial aortic valve replacement (hazard ratio 0.95; 95% CI: 0.7, 1.3; P = 0.7). For mitral valve replacement patients, long-term survival was poorer than after aortic valve replacement (hazard ratio 1.4; 95% CI: 1.1, 1.8; P = 0.003), but again no detrimental effect was associated with use of a tissue versus a mechanical prosthesis (hazard ratio 0.9; 95% CI 0.5, 1.4; P = 0.5).Conclusions - In our experience, selecting a tissue prosthesis at initial operation in younger adults does not negatively impact survival into the third decade of follow-up, despite the risk of reoperation.