Yanagawa Bobby, Lee Jessica, Ouzounian Maral, Bagai Akshay, Cheema Asim, Verma Subodh, Friedrich Jan O
Divisions of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
J Card Surg. 2020 Apr;35(4):818-825. doi: 10.1111/jocs.14478. Epub 2020 Feb 24.
The optimal mitral prosthesis in young patients is unclear. This systematic review and meta-analysis were performed to compare outcomes between bileaflet mechanical mitral valve replacement (mMVR) and bioprosthesis mitral valve replacement (bioMVR) for MVR patients aged less than 70 years.
We searched MEDLINE and EMBASE databases from inception to July 2018 for studies comparing surgical outcomes of mMVR vs bioMVR.
There were 14 observational studies with 20 219 patients (n = 14 658 mMVR and n = 5561 bioMVR). Patients receiving an mMVR were younger with fewer comorbidities including renal failure, dialysis, and less-infective endocarditis (P < .001). The estimated 10-year mortality ranged from 19% to 49% for mMVR and 22% to 58% for bioMVR among studies. Comparing matched or adjusted data, mMVR was associated with lower operative (risk ratio [RR]: 0.61; 95% confidence interval [CI]: 0.39, 0.94; P = .03) and long-term (HR: 0.81; 95% CI: 0.71, 0.92; P = .002) mortality at a median follow-up of 8 years (IQR: 6-10 years). Estimated 10-year risk for mitral valve reoperation ranged from 0% to 8% for mMVR and 8% to 22% for bioMVR among matched/adjusted studies. mMVR was associated with lower matched/adjusted risk of reoperation (HR: 0.35; 95% CI: 0.19, 0.65; P = .001) but with greater risk of bleeding (HR: 1.59; 95% CI: 1.19, 2.13; P = .002) and a trend to greater risk of stroke and embolism (HR: 1.70; 95% CI: 0.92, 3.15; P = .09).
Mechanical MVR in patients aged less than 70 years is associated with a lower risk of operative mortality as well as a 20% lower risk of long-term death and 65% lower risk of mitral valve reoperation but 60% greater risk of bleeding compared with bioMVR in matched or adjusted data.
年轻患者的最佳二尖瓣假体尚不明确。本系统评价和荟萃分析旨在比较年龄小于70岁的二尖瓣置换术（MVR）患者接受双叶机械二尖瓣置换术（mMVR）和生物瓣二尖瓣置换术（bioMVR）后的结局。
我们检索了MEDLINE和EMBASE数据库自创建至2018年7月的研究，以比较mMVR与bioMVR的手术结局。
有14项观察性研究，共20219例患者（n = 14658例mMVR和n = 5561例bioMVR）。接受mMVR的患者更年轻，合并症更少，包括肾衰竭、透析，感染性心内膜炎也更少（P <.001）。研究中，mMVR的估计10年死亡率为19%至49%，bioMVR为22%至58%。比较匹配或调整后的数据，在中位随访8年（四分位间距：6 - 10年）时，mMVR与较低的手术死亡率（风险比[RR]：0.61；95%置信区间[CI]：0.39，0.94；P = 0.03）和长期死亡率（风险比[HR]：0.81；95%CI：0.71，0.92；P = 0.002）相关。在匹配/调整后的研究中，mMVR的二尖瓣再次手术估计10年风险为0%至8%，bioMVR为8%至22%。mMVR与较低的匹配/调整后再次手术风险相关（HR：0.35；95%CI：0.19，0.65；P = 0.001），但出血风险更高（HR：1.59；95%CI：1.19，2.13；P = 0.002），且有中风和栓塞风险增加的趋势（HR：1.70；95%CI：0.92，3.15；P = 0.09）。
在匹配或调整后的数据中，年龄小于70岁的患者接受机械MVR与较低的手术死亡风险相关，长期死亡风险降低20%，二尖瓣再次手术风险降低65%，但出血风险增加60%，与bioMVR相比。
