Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement
Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement
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DOI：
10.1056/nejmoa1613792
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发表时间：
2017-11-09
影响因子：
158.5
通讯作者：
Woo, Y. Joseph
中科院分区：
文献类型：
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作者：
Goldstone, Andrew B.;Chiu, Peter;Woo, Y. Joseph
背景在接受二尖瓣或二尖瓣置换术的患者中，使用机械或生物假体。尽管有限的证据支持这一做法，生物假体已越来越受青睐。METHODS我们比较了长期死亡率和再手术率，中风和出血之间的逆概率加权队列的患者谁经历了主动脉瓣置换术或二尖瓣置换与机械或生物假体在加州在1996年至2013年期间。根据瓣膜位置（主动脉瓣与二尖瓣）将患者分为不同年龄组。从1996年到2013年，生物瓣膜在主动脉瓣和二尖瓣置换术中的使用大幅增加，主动脉瓣置换术从11.5%增加到51.6%，二尖瓣置换术从16.8%增加到53.7%。在接受主动脉瓣置换术的患者中，在45 - 54岁的患者中，接受生物假体的患者15年死亡率显著高于接受机械假体的患者（15年时为30.6% vs. 26.4%;风险比为1.23; 95%置信区间[CI]为1.02 - 1.48; P = 0.03），但在55 - 64岁的患者中未发生。在接受二尖瓣置换术的患者中，在40 - 49岁的患者中，接受生物假体的患者死亡率显著高于接受机械假体的患者（44.1% vs. 27.1%;风险比，1.88; 95%CI，1.35 - 2.63; P
BACKGROUNDIn patients undergoing aortic-valve or mitral-valve replacement, either a mechanical or biologic prosthesis is used. Biologic prostheses have been increasingly favored despite limited evidence supporting this practice.METHODSWe compared long-term mortality and rates of reoperation, stroke, and bleeding between inverse-probability-weighted cohorts of patients who underwent primary aortic-valve replacement or mitral-valve replacement with a mechanical or biologic prosthesis in California in the period from 1996 through 2013. Patients were stratified into different age groups on the basis of valve position (aortic vs. mitral valve).RESULTSFrom 1996 through 2013, the use of biologic prostheses increased substantially for aortic-valve and mitral-valve replacement, from 11.5% to 51.6% for aortic-valve replacement and from 16.8% to 53.7% for mitral-valve replacement. Among patients who underwent aortic-valve replacement, receipt of a biologic prosthesis was associated with significantly higher 15-year mortality than receipt of a mechanical prosthesis among patients 45 to 54 years of age (30.6% vs. 26.4% at 15 years; hazard ratio, 1.23; 95% confidence interval [CI], 1.02 to 1.48; P = 0.03) but not among patients 55 to 64 years of age. Among patients who underwent mitral-valve replacement, receipt of a biologic prosthesis was associated with significantly higher mortality than receipt of a mechanical prosthesis among patients 40 to 49 years of age (44.1% vs. 27.1%; hazard ratio, 1.88; 95% CI, 1.35 to 2.63; P