Zhao Dong Fang, Seco Michael, Wu James J, Edelman James B, Wilson Michael K, Vallely Michael P, Byrom Michael J, Bannon Paul G
Sydney Medical School, University of Sydney, Sydney, Australia; Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia.
Sydney Medical School, University of Sydney, Sydney, Australia.
Ann Thorac Surg. 2016 Jul;102(1):315-27. doi: 10.1016/j.athoracsur.2015.10.092. Epub 2016 Jan 12.
The choice of a bioprosthetic valve (BV) or mechanical valve (MV) in middle-aged adults undergoing aortic valve replacement is a complex decision that must account for numerous prosthesis and patient factors. A systematic review and meta-analysis was performed to compare long-term survival, major adverse prosthesis-related events, anticoagulant-related events, major bleeding, reoperation, and structural valve degeneration in middle-aged patients receiving a BV or MV. A comprehensive search from six electronic databases was performed from their inception to February 2016. Results from patients aged less than 70 years undergoing aortic valve replacement with a BV or MV were included. There were 12 studies involving 8,661 patients. Baseline characteristics were similar. There was no significant difference in long-term survival among patients aged 50 to 70 or 60 to 70 years. Compared with MVs, BVs had significantly fewer long-term anticoagulant-related events (hazard ratio [HR] 0.54, p = 0.006) and bleeding (HR 0.48, p < 0.00001) but significantly greater major adverse prosthesis-related events (HR 1.82, p = 0.02), including reoperation (HR 2.19, p < 0.00001). The present meta-analysis found no significant difference in survival between BVs and MVs in patients aged 50 to 70 or 60 to 70 years. Compared with MVs, BVs have reduced risk of major bleeding and anticoagulant-related events but increased risk of structural valve degeneration and reoperation. However, the mortality consequences of reoperation appear lower than that of major bleeding, and recent advances may further lower the reoperation rate for BV. Therefore, this review supports the current trend of using BVs in patients more than 60 years of age.
对于接受主动脉瓣置换术的中年成年人而言，选择生物瓣（BV）还是机械瓣（MV）是一个复杂的决定，必须考虑众多假体和患者因素。我们进行了一项系统评价和荟萃分析，以比较接受BV或MV的中年患者的长期生存率、主要假体相关不良事件、抗凝相关事件、大出血、再次手术以及瓣膜结构退变情况。从六个电子数据库建库起至2016年2月进行了全面检索。纳入了年龄小于70岁、接受BV或MV主动脉瓣置换术患者的结果。共有12项研究，涉及8661例患者。基线特征相似。50至70岁或60至70岁患者的长期生存率无显著差异。与MV相比，BV的长期抗凝相关事件（风险比[HR] 0.54，p = 0.006）和出血（HR 0.48，p < 0.00001）显著更少，但主要假体相关不良事件（HR 1.82，p = 0.02）显著更多，包括再次手术（HR 2.19，p < 0.00001）。本荟萃分析发现，50至70岁或60至70岁患者中，BV和MV的生存率无显著差异。与MV相比，BV发生大出血和抗凝相关事件的风险降低，但瓣膜结构退变和再次手术的风险增加。然而，再次手术的死亡后果似乎低于大出血，并且最近的进展可能会进一步降低BV的再次手术率。因此，本综述支持目前在60岁以上患者中使用BV的趋势。
