Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
PLoS One. 2019 Aug 19;14(8):e0221263. doi: 10.1371/journal.pone.0221263. eCollection 2019.
We examined trends, characteristics and in-hospital outcomes in mechanical and bioprosthetic surgical mitral valve replacement (SMVR) among patients with and without chronic obstructive pulmonary disease (COPD) in Spain from 2001 to 2015. We also identified factors associated with in-hospital mortality (IHM) in both groups of patients according to the implanted valve type.
We analyzed data from the Spanish National Hospital Discharge Database for patients aged 40 years or over. We selected admissions of patients whose medical procedures included SMVR. We grouped hospitalizations by COPD status.
Over 43,024 patients identified, 83.63% underwent mechanical mitral valve replacement and 16.37% bioprosthetic valve (6.71% and 7.78% with COPD, respectively). The incidence of SMVR decreased for mechanical valves and increased for bioprosthetic valves over time in both groups of patients. The incidence of SMVR admissions was lower among COPD patients than in those without COPD, both for mechanical and bioprosthetic valves. IHM decreased significantly over time, regardless of the type of valve, in both groups of patients. COPD was associated with a significant increase in IHM, but only among patients who underwent bioprosthetic SMVR (OR 1.32, 95% CI 1.01-1.73).
The incidence of mechanical SMVR decreased while that of bioprosthetic SMVR increased over time in both groups of patients. COPD patients were less surgically operated than non-COPD patients for both valve types. In COPD patients, bioprosthetic SMVR was proportionally more used than mechanical SMVR. Mortality decreased over time for both valve types in patients with and without COPD. COPD increased in-hospital mortality among patients undergoing a biological SMVR.
我们研究了 2001 年至 2015 年期间西班牙患有和不患有慢性阻塞性肺疾病（COPD）的患者进行机械和生物瓣二尖瓣置换术（SMVR）的趋势、特征和院内结局。我们还根据植入瓣膜的类型，确定了两组患者与院内死亡率（IHM）相关的因素。
我们分析了西班牙国家住院数据库中年龄在 40 岁及以上的患者数据。我们选择了接受 SMVR 手术的患者的入院记录。我们根据 COPD 状况对住院进行分组。
在确定的 43024 名患者中，83.63%接受了机械二尖瓣置换术，16.37%接受了生物瓣置换术（分别有 6.71%和 7.78%的患者患有 COPD）。两组患者的机械瓣膜 SMVR 发生率呈下降趋势，生物瓣 SMVR 发生率呈上升趋势。与非 COPD 患者相比，患有 COPD 的患者机械和生物瓣 SMVR 入院率均较低。两组患者无论瓣膜类型如何，IHM 均随时间显著下降。COPD 与 IHM 显著增加相关，但仅在接受生物瓣 SMVR 的患者中（OR 1.32，95%CI 1.01-1.73）。
两组患者的机械 SMVR 发生率呈下降趋势，生物瓣 SMVR 发生率呈上升趋势。与非 COPD 患者相比，两组患者的机械瓣膜和生物瓣膜手术均较少。在 COPD 患者中，生物瓣 SMVR 的使用比例高于机械瓣 SMVR。两组患者无论是否患有 COPD，瓣膜类型死亡率均随时间下降。COPD 增加了接受生物瓣 SMVR 的患者的院内死亡率。
