Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University.
Circ J. 2018 Jul 25;82(8):2041-2048. doi: 10.1253/circj.CJ-18-0003. Epub 2018 May 24.
This study compared the long-term outcomes of prosthetic heart valve replacement with mechanical or bioprosthetic valves in patients with prior stroke.
In total, 1,984 patients with previous stroke who had received valve replacement between 2000 and 2011 were identified using the Taiwan National Health Insurance Research Database. Propensity score matching analysis was used. Ultimately, 547 patients were extracted from each group and were eligible for analysis. On survival analysis, the risks of all-cause mortality and recurrence of stroke were similar. The incidence of major bleeding was greater in the mechanical valve group than in the bioprosthetic valve group (P=0.040), whereas no difference was observed in re-do valve surgery. On subgroup analysis, the bioprosthetic valve was favored for older age (≥60 years) and previous gastrointestinal (GI) bleeding patients. The mechanical valve, however, was favored for younger patients (<60 years).
In patients with previous stroke, bioprosthetic valves had a lower incidence of complications connected to major bleeding than did the mechanical valves. Survival and stroke recurrence rates, however, did not differ between the 2 groups. We recommend bioprosthetic valves for patients >60 years or who have a history of GI bleeding.
本研究比较了既往卒中患者行机械瓣或生物瓣置换的长期预后。
利用台湾全民健康保险研究数据库，共纳入 2000 年至 2011 年间接受瓣膜置换术的 1984 例既往卒中患者。采用倾向评分匹配分析。最终，每组各有 547 例患者符合分析条件。生存分析显示，全因死亡率和卒中复发风险相似。机械瓣组大出血发生率高于生物瓣组（P=0.040），但再次瓣膜手术无差异。亚组分析显示，生物瓣更适用于年龄较大（≥60 岁）和既往有胃肠道（GI）出血的患者。而机械瓣更适用于年龄较小（＜60 岁）的患者。
对于既往卒中患者，生物瓣的严重出血相关并发症发生率低于机械瓣。然而，两组的生存率和卒中复发率无差异。我们建议对于＞60 岁或有 GI 出血史的患者使用生物瓣。
