Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Quality Control Center of Cardiovascular Surgery, Health Committee of Hubei Province, Wuhan, China.
Clin Cardiol. 2020 Oct;43(10):1093-1099. doi: 10.1002/clc.23407. Epub 2020 Jun 4.
The optimal choice of the valve prosthesis in mitral valve replacement (MVR) for infective endocarditis (IE) is controversial and challenging, particularly for younger patients.
The postoperative outcomes of mechanical and biological MVR in IE patients aged 50 to 69 years are different.
All IE patients aged 50 to 69 years with primary MVR in Hubei province hospitals from 2002 to 2018 were retrospectively reviewed. The median duration of follow-up was 8.7 years (IQR, 6.8-10.9 years). Propensity score matching (1:3 ratio) was used to yield 492 patients with comparable baseline features between bioprostheses and mechanical prosthetic valve groups. Outcomes were postoperative mid- to long- term survival, mitral valve reoperation, prosthetic valve endocarditis (PVE), stroke, and major bleeding events.
Fifteen-year survival after MVR was 80.6% in the mechanical valve group and 69.3% in the bioprostheses group (HR 0.545, P = .040). The cumulative incidence of mitral valve reoperation was 8.8% with mechanical valves and 21.4% with bioprostheses (HR 0.260, P = .002). The cumulative incidence of PVE was 5.6% with mechanical valves and 7.2% with bioprostheses (HR 0.629, P = .435). The cumulative incidence of stroke was 12.9% with mechanical valves and 10.5% with bioprostheses (HR 1.217, P = .647). The cumulative incidence of major bleeding was 12.0% with mechanical valves and 6.75% with bioprostheses (HR 1.579, P = .268).
Mechanical valve prostheses were associated with better survival, lower rates of reoperation compared with bioprostheses within 15 years after MVR in IE patients aged 50 to 69. These findings suggest mechanical valve prostheses may be a more reasonable alternative to bioprostheses in this patient group.
感染性心内膜炎（IE）患者行二尖瓣置换术（MVR）时，人工机械瓣膜和生物瓣膜的最佳选择存在争议，尤其是在年轻患者中。
50 岁至 69 岁 IE 患者行机械瓣和生物瓣 MVR 的术后结局不同。
回顾性分析 2002 年至 2018 年湖北省各医院 50 岁至 69 岁行初次 MVR 的所有 IE 患者。中位随访时间为 8.7 年（IQR：6.8-10.9 年）。采用倾向性评分匹配（1:3 比例）将生物瓣和机械瓣组各匹配 492 例患者，以获得基线特征可比的患者。观察术后中至长期生存、二尖瓣再次手术、人工瓣膜心内膜炎（PVE）、卒中和大出血事件等结局。
机械瓣组和生物瓣组患者 MVR 后 15 年生存率分别为 80.6%和 69.3%（HR 0.545，P =.040）。机械瓣组和生物瓣组患者二尖瓣再次手术的累积发生率分别为 8.8%和 21.4%（HR 0.260，P =.002）。机械瓣组和生物瓣组患者 PVE 的累积发生率分别为 5.6%和 7.2%（HR 0.629，P =.435）。机械瓣组和生物瓣组患者卒中的累积发生率分别为 12.9%和 10.5%（HR 1.217，P =.647）。机械瓣组和生物瓣组患者大出血的累积发生率分别为 12.0%和 6.75%（HR 1.579，P =.268）。
50 岁至 69 岁 IE 患者行 MVR 后 15 年内，与生物瓣相比，机械瓣的生存率更高，再次手术率更低。这些发现表明，在该患者人群中，机械瓣可能是生物瓣的一种更合理的替代选择。
