Bioprosthetic Versus Mechanical Valve Replacement for Infective Endocarditis: Focus on Recurrence Rates
Bioprosthetic Versus Mechanical Valve Replacement for Infective Endocarditis: Focus on Recurrence Rates
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DOI：
10.1016/j.athoracsur.2017.12.046
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发表时间：
2018-07-01
影响因子：
4.6
通讯作者：
Sundt, Thoralf M.
中科院分区：
文献类型：
--
作者：
Toyoda, Nana;Itagaki, Shinobu;Sundt, Thoralf M.
背景感染性心内膜炎假体选择的共识指南建议根据预期寿命和合并症进行生物瓣膜或机械瓣膜置换。然而，当代的结果数据仅限于机构系列。从加州和纽约的强制出院数据库中识别的3，447例患者的结局，这些患者患有原发性孤立二尖瓣（n = 1，603）或主动脉根据是否接受生物瓣膜，对1998年至2010年期间因活动性心内膜炎进行瓣膜置换的患者（n = 1，844）进行了比较（n = 1，673，48.5%）或机械（n = 1，774，51.5%）瓣膜。药物滥用者作为一个单独的队列进行分析。主要结局为心内膜炎复发。中位随访时间为6.8年（范围：0 - 12年）。末次生存随访时间为2015年12月31日。接受生物瓣膜的患者年龄较大（60.4 +/- 14.9岁vs 53.4 +/- 14.3岁，p < 0.001），合并症较多。二尖瓣（调整后风险比1.14，95%置信区间[CI]：0.98 - 1.34，p = 0.10）或主动脉瓣（调整后风险比1.10，95% CI：0.93 - 1.29，p = 0.26）置换术后，生物瓣膜与机械瓣膜的12年生存率无显著差异。生物瓣膜和机械瓣膜的12年复发率相似：10.4%（95% CI：8.0%-13.1%）vs 8.8%（95% CI：6.9%-10.9%），二尖瓣置换术后校正的考克斯p = 0.79;和9.4%（95% CI：7.5%至11.6%）与10.0%（95% CI：8.0%至12.4%），主动脉瓣置换术后校正的考克斯p = 0.81。生物瓣膜和机械瓣膜的生存率和心内膜炎复发率相似。这些数据支持指南的建议，即患者因素指导感染性心内膜炎的假体选择。(C)2018胸外科医师协会
Background. Consensus guidelines for prosthesis selection in infective endocarditis recommend bioprosthetic or mechanical valve replacement based on life expectancy and comorbidity. However, contemporary outcome data are limited to institution series.Methods. The outcomes of 3,447 patients identified from mandatory discharge databases in California and New York who had either primary isolated mitral (n = 1,603) or aortic (n = 1,844) valve replacement for active endocarditis between 1998 and 2010 were compared according to whether they received bioprosthetic (n = 1,673, 48.5%) or mechanical (n = 1,774, 51.5%) valves. Drug abusers were analyzed as a separate cohort. The primary outcome was endocarditis recurrence. Median follow-up time was 6.8 years (range, 0 to 12). Last followup for survival was December 31, 2015.Results. Patients receiving bioprosthetic valves were older (60.4 +/- 14.9 versus 53.4 +/- 14.3 years, p < 0.001), with more comorbidity. There was no significant difference in 12-year survival with bioprosthetic versus mechanical valves after mitral (adjusted hazard ratio 1.14, 95% confidence interval [CI]: 0.98 to 1.34, p = 0.10) or aortic (adjusted hazard ratio 1.10, 95% CI: 0.93 to 1.29, p = 0.26) valve replacement. Bioprosthetic and mechanical valves were associated with similar recurrence rates at 12 years: 10.4% (95% CI: 8.0% to 13.1%) versus 8.8% (95% CI: 6.9% to 10.9%), adjusted Cox p = 0.79 after mitral replacement; and 9.4% (95% CI: 7.5% to 11.6%) versus 10.0% (95% CI: 8.0% to 12.4%), adjusted Cox p = 0.81 after aortic valve replacement.Conclusions. Bioprosthetic and mechanical valves are associated with similar survival and freedom from endocarditis recurrence. These data support guideline recommendations that patient factors guide prosthesis choice in infective endocarditis. (C) 2018 by The Society of Thoracic Surgeons