Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Ann Thorac Surg. 2014 Apr;97(4):1314-20. doi: 10.1016/j.athoracsur.2013.10.078. Epub 2014 Jan 11.
The objective was to compare late survival after aortic valve replacement (AVR) with a Carpentier-Edwards Perimount (Edwards Lifesciences, Irvine, CA) versus a Mosaic bioprosthesis (Medtronic Inc, Minneapolis, MN). Secondary objectives were to compare early mortality, the rate of reoperation, and the effect of prosthesis-patient mismatch (PPM) on late survival.
The design was a population-based cohort study including all patients who underwent AVR with a Perimount or Mosaic bioprosthesis at our institution between 2002 and 2010. Baseline, operative characteristics and clinical outcomes were collected from patient charts and national registers. The primary outcome was all-cause mortality. We analyzed the unadjusted and multivariable adjusted association between valve type and late survival.
In total, 1,219 patients received the Perimount (n=864) or the Mosaic (n=355) bioprosthesis. During a mean follow-up of 4.2 and 6.9 years, there were 193 and 177 deaths in the Perimount and Mosaic groups, respectively. The unadjusted 1-, 5-, and 8-year survival was 93%, 78%, and 63%, respectively, in the Perimount group and 92%, 80%, and 57%, respectively, in the Mosaic group (p=0.971).There was no significant association between valve choice and all-cause mortality in the multivariable analysis (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.65-1.11). Freedom from aortic valve reoperation was similar between the groups. No significant association was found between severe PPM and late mortality.
We found no significant difference in late survival after AVR with a Perimount bioprosthesis compared with a Mosaic bioprosthesis. Even though severe PPM was more common in the Mosaic group, it did not affect the late survival or the frequency of reoperation.
本研究旨在比较主动脉瓣置换术（AVR）后使用 Carpentier-Edwards Perimount（爱德华生命科学公司，加利福尼亚州欧文）与 Mosaic 生物瓣的晚期存活率。次要目标是比较早期死亡率、再次手术率以及人工瓣膜-患者不匹配（PPM）对晚期存活率的影响。
该研究为基于人群的队列研究，纳入了 2002 年至 2010 年期间在我院行 Perimount 或 Mosaic 生物瓣 AVR 的所有患者。从患者病历和国家登记处收集基线、手术特征和临床结局数据。主要结局为全因死亡率。我们分析了瓣膜类型与晚期存活率之间的未调整和多变量调整关联。
共 1219 例患者接受了 Perimount（n=864）或 Mosaic（n=355）生物瓣。平均随访 4.2 年和 6.9 年后，Perimount 组和 Mosaic 组分别有 193 例和 177 例死亡。Perimount 组的未调整 1 年、5 年和 8 年生存率分别为 93%、78%和 63%，Mosaic 组分别为 92%、80%和 57%（p=0.971）。多变量分析中，瓣膜选择与全因死亡率之间无显著相关性（风险比[HR]，0.85；95%置信区间[CI]，0.65-1.11）。两组主动脉瓣再次手术率相似。严重 PPM 与晚期死亡率之间也未发现显著关联。
与使用 Mosaic 生物瓣相比，使用 Perimount 生物瓣行 AVR 后晚期存活率无显著差异。尽管 Mosaic 组中严重 PPM 更为常见，但并未影响晚期存活率或再次手术率。
