Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
J Thorac Cardiovasc Surg. 2014 Jun;147(6):1884-91. doi: 10.1016/j.jtcvs.2013.07.005. Epub 2013 Aug 26.
We addressed the long-term results of the Medtronic Mosaic porcine prosthesis in the aortic position.
From 1994 to 2004, 1007 Mosaic valves were used for aortic valve replacement. The data were prospectively collected, retrospectively analyzed, and stratified according to patient age at surgery (group 1, <70 years; group 2, 70-75 years; group 3, 76-80 years; and group 4, >80 years), using both actual (cumulative risks) and actuarial methods.
Operative mortality was 5% (valve related in 14%). Globally, 8122.17 patient-years were available (average follow-up, 8.5 ± 3.9 years; 99.8% complete). Overall, survival at 15 years was lower among the elderly strata (P < .0001). Freedom from structural valve deterioration (SVD) was 95.1% (actual) and 86.3% (actuarial; 24 SVD events). Survival free from SVD was lower in group 1 (P = .003) but comparable among the other groups. Overall freedom at 15 years from the composite endpoint (any valve-related adverse events) was 82% (actual) and 71.3% (actuarial). No meaningful intergroup differences were found in survival free from the composite endpoint (P = .9) or freedom from valve-related mortality (P = .8). Younger patients at surgery did not show accelerated degeneration. No relationship could be established between prosthetic size and SVD.
The implantation of a bioprosthesis in patients aged 70 years or older remains fully justified. The rate of SVD was higher in younger patients, mainly owing to their greater life expectancy. Patients younger than 70 can receive a bioprosthesis, provided that the correct information regarding the expected durability has been provided. This might be better accomplished through the actual methodology.
我们探讨了美敦力马赛克猪生物瓣在主动脉瓣位置的长期结果。
1994 年至 2004 年，1007 枚马赛克瓣用于主动脉瓣置换术。前瞻性收集数据，回顾性分析，并根据手术时患者年龄进行分层（组 1，<70 岁；组 2，70-75 岁；组 3，76-80 岁；组 4，>80 岁），使用实际（累积风险）和计算方法。
手术死亡率为 5%（瓣膜相关 14%）。共有 8122.17 患者-年（平均随访 8.5±3.9 年；99.8%完整）。总体而言，老年组的 15 年生存率较低（P<.0001）。结构性瓣膜退化（SVD）的无失败率为 95.1%（实际）和 86.3%（计算；24 例 SVD 事件）。SVD 无失败生存率在组 1 中较低（P=.003），但其他组之间无差异。15 年时无复合终点（任何瓣膜相关不良事件）的生存率为 82%（实际）和 71.3%（计算）。各组间在无复合终点生存率（P=.9）或瓣膜相关死亡率（P=.8）方面无明显差异。手术时年龄较小的患者未出现加速退化。假体尺寸与 SVD 之间无关联。
对于 70 岁或以上的患者植入生物瓣仍然完全合理。SVD 发生率在年轻患者中较高，主要是由于其预期寿命较长。对于年龄小于 70 岁的患者，如果已提供有关预期耐久性的正确信息，可以接受生物瓣。通过实际方法可能更好地实现这一目标。
