Department of Cardiology, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
Department of Cardiac Surgery, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
J Thorac Cardiovasc Surg. 2023 Feb;165(2):634-644.e5. doi: 10.1016/j.jtcvs.2021.01.094. Epub 2021 Feb 3.
Prosthetic choice for mitral valve replacement is generally driven by patient age and patient and surgeon preference, and current guidelines do not discriminate between different etiologies of mitral valve disease. Our objective was to assess and compare short- and long-term outcomes after mitral valve replacement among patients with biological or mechanical prostheses in the setting of severe ischemic mitral regurgitation.
Between 2000 and 2016, 424 patients underwent mitral valve replacement for severe ischemic mitral regurgitation at our institution, using biological prosthesis in 188 (44%) and mechanical prosthesis in 236 (56%). A 1:1 propensity score match (n = 126 per group) and inverse probability of treatment weighting were used to compare groups. Short-term outcomes included in-hospital mortality and other cardiovascular adverse events. Long-term outcomes included survival and hospital readmission for cardiovascular causes, stroke, and major bleeding.
In-hospital mortality and early postoperative adverse events were similar between groups in the propensity score match and inverse probability of treatment weighting cohorts. Overall long-term survival was similar at 5 and 9 years, but mechanical prosthesis recipients were more frequently readmitted to hospital for cardiovascular causes, including stroke and non-neurological bleeding in propensity score matching and inverse probability of treatment weighting analyses (all P values < .004). Type of prosthesis did not independently influence all-cause mortality (hazard ratio, 1.01; 95% confidence interval, 0.71-1.43; P = .959), but placement of a mechanical prosthesis was associated with increased risk of readmission for cardiovascular events (hazard ratio, 1.65; 95% confidence interval, 1.17-2.32; P = .004) among matched patients.
The type of prosthesis has no influence on long-term survival among patients with severe ischemic mitral regurgitation undergoing mitral valve replacement. There may be an increased risk of neurologic events and serious bleeding associated with mechanical prostheses.
二尖瓣置换的人工瓣膜选择通常取决于患者年龄、患者和外科医生的偏好，而目前的指南并没有区分二尖瓣疾病的不同病因。我们的目的是评估和比较在严重缺血性二尖瓣反流的情况下，使用生物瓣或机械瓣的患者在二尖瓣置换后的短期和长期结局。
在 2000 年至 2016 年期间，我院共有 424 例严重缺血性二尖瓣反流患者接受二尖瓣置换术，其中使用生物瓣 188 例（44%），机械瓣 236 例（56%）。采用 1:1 倾向评分匹配（每组 126 例）和逆概率处理权重法比较两组。短期结局包括院内死亡率和其他心血管不良事件。长期结局包括生存和因心血管原因、中风和主要出血再次住院。
在倾向评分匹配和逆概率处理权重队列中，两组患者的院内死亡率和早期术后不良事件相似。整体 5 年和 9 年生存率相似，但在倾向评分匹配和逆概率处理权重分析中，机械瓣患者因心血管原因（包括中风和非神经出血）再次住院的频率更高（所有 P 值均<.004）。人工瓣膜类型并不独立影响全因死亡率（风险比，1.01；95%置信区间，0.71-1.43；P=.959），但在匹配患者中，机械瓣的放置与心血管事件再入院风险增加相关（风险比，1.65；95%置信区间，1.17-2.32；P=.004）。
在接受二尖瓣置换术的严重缺血性二尖瓣反流患者中，人工瓣膜类型对长期生存率没有影响。机械瓣可能与神经事件和严重出血的风险增加有关。
