Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.
Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.
J Thorac Cardiovasc Surg. 2019 Sep;158(3):706-714.e18. doi: 10.1016/j.jtcvs.2018.10.146. Epub 2018 Nov 20.
In recent years, the use of surgically implanted biological aortic valves has been favored over mechanical prosthesis in patients between 50 and 70 years of age. However, outcomes on long-term survival are contradictory. The objective of this study was to determine if patients with mechanical valves have worse long-term survival than patients with biological prostheses.
We systematically searched published studies that: (1) were propensity score-matched or randomized controlled trials; (2) provided survival data with a minimum follow-up of 5 years; and (3) included patients older than 50 and younger than 70 years of age. Review articles, case reports, and editorials were excluded. We conducted a meta-analysis on the basis of 2 types of analysis. A reconstruction of the database of each study to simulate a patient-level meta-analysis was performed. Log rank test of Kaplan-Meier curves was recalculated. Hazard ratio (HR) was calculated using a univariate Cox regression. In addition, we calculated a pooled HR using the fixed-effect inverse variance method.
Four propensity score-matched studies and 1 randomized controlled trial met the inclusion criteria. Data of 4686 patients were analyzed. Survival rates for mechanical versus biological valves at 10 and 15 years of follow-up were: 76.78% (95% confidence interval [CI], 74.72%-78.69%) versus 74.09% (95% CI, 71.96%-76.08%), and 61.58% (95% CI, 58.29%-64.69%) versus 58.04% (95% CI, 54.57%-61.35%). Log rank test was statistically significant (P = .012) and the pooled HR was 0.86 (95% CI, 0.76-0.97; P = .01).
Compared with biological aortic valves, mechanical valves are associated with a long-term survival benefit for patients between 50 and 70 years.
近年来，在 50 至 70 岁的患者中，使用外科植入的生物主动脉瓣已优于机械假体。然而，长期生存结果存在争议。本研究的目的是确定机械瓣膜患者的长期生存是否比生物假体患者差。
我们系统地检索了已发表的研究，这些研究：（1）是倾向评分匹配或随机对照试验；（2）提供了至少 5 年随访的生存数据；（3）纳入了年龄大于 50 岁且小于 70 岁的患者。排除了综述文章、病例报告和社论。我们根据两种分析类型进行了荟萃分析。对每项研究的数据库进行重建，以模拟患者水平的荟萃分析。重新计算 Kaplan-Meier 曲线的对数秩检验。使用单变量 Cox 回归计算危险比（HR）。此外，我们使用固定效应逆方差法计算了合并的 HR。
四项倾向评分匹配研究和一项随机对照试验符合纳入标准。分析了 4686 名患者的数据。机械瓣膜与生物瓣膜在 10 年和 15 年随访时的生存率分别为：76.78%（95%置信区间[CI]，74.72%-78.69%）与 74.09%（95% CI，71.96%-76.08%），61.58%（95% CI，58.29%-64.69%）与 58.04%（95% CI，54.57%-61.35%）。对数秩检验具有统计学意义（P=0.012），合并的 HR 为 0.86（95% CI，0.76-0.97；P=0.01）。
与生物主动脉瓣相比，机械瓣膜与 50 至 70 岁患者的长期生存获益相关。
