机械主动脉瓣与生物主动脉瓣长期结局的比较——倾向评分分析
Comparison of the Long-Term Outcomes of Mechanical and Bioprosthetic Aortic Valves - A Propensity Score Analysis.
作者信息
Minakata Kenji, Tanaka Shiro, Tamura Nobushige, Yanagi Shigeki, Ohkawa Yohei, Okonogi Shuichi, Kaneko Tatsuo, Usui Akihiko, Abe Tomonobu, Shimamoto Mitsuomi, Takahara Yoshiharu, Yamanaka Kazuo, Yaku Hitoshi, Sakata Ryuzo
机构信息
Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine.
Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health.
出版信息
Circ J. 2017 Jul 25;81(8):1198-1206. doi: 10.1253/circj.CJ-17-0154. Epub 2017 Apr 12.
BACKGROUND
The aim of this study was to assess the long-term outcomes of aortic valve replacement (AVR) with either mechanical or bioprosthetic valves according to age at operation.
METHODS AND RESULTS
A total of 1,002 patients (527 mechanical valves and 475 bioprosthetic valves) undergoing first-time AVR were categorized according to age at operation: group Y, age <60 years; group M, age 60-69 years; and group O, age ≥70 years). Outcomes were compared on propensity score analysis (adjusted for 28 variables). Hazard ratio (HR) was calculated using the Cox regression model with adjustment for propensity score with bioprosthetic valve as a reference (HR=1). There were no significant differences in overall mortality between mechanical and bioprosthetic valves for all age groups. Valve-related mortality was significantly higher for mechanical valves in group O (HR, 2.53; P=0.02). Reoperation rate was significantly lower for mechanical valves in group Y (HR, 0.16; P<0.01) and group M (no events for mechanical valves). Although the rate of thromboembolic events was higher in mechanical valves in group Y (no events for tissue valves) and group M (HR, 9.05; P=0.03), there were no significant differences in bleeding events between all age groups.
CONCLUSIONS
The type of prosthetic valve used in AVR does not significantly influence overall mortality.
背景
本研究旨在根据手术时的年龄评估机械瓣膜或生物瓣膜置换主动脉瓣（AVR）的长期结果。
方法与结果
共有1002例首次接受AVR的患者（527例机械瓣膜和475例生物瓣膜）根据手术时的年龄进行分类：Y组，年龄<60岁；M组，年龄60 - 69岁；O组，年龄≥70岁。通过倾向评分分析（针对28个变量进行调整）比较结果。使用Cox回归模型计算风险比（HR），以生物瓣膜为参照对倾向评分进行调整（HR = 1）。所有年龄组中，机械瓣膜和生物瓣膜的总死亡率无显著差异。O组中机械瓣膜的瓣膜相关死亡率显著更高（HR，2.53；P = 0.02）。Y组中机械瓣膜的再次手术率显著更低（HR，0.16；P < 0.01），M组中机械瓣膜无再次手术事件。尽管Y组（生物瓣膜无事件）和M组中机械瓣膜的血栓栓塞事件发生率更高（HR，9.05；P = 0.03），但所有年龄组的出血事件无显著差异。
结论
AVR中使用的人工瓣膜类型对总死亡率无显著影响。
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