Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK.
Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland.
Eur J Cardiothorac Surg. 2021 May 8;59(5):1077-1086. doi: 10.1093/ejcts/ezaa429.
There is no consensus regarding the use of biological or mechanical prostheses in patients 50-69 years of age. Previous studies have reported a survival advantage with mechanical valves. Our goal was to compare the long-term survival of patients in the intermediate age groups of 50-59 and 60-69 years receiving mechanical or biological aortic valve prostheses.
We conducted a retrospective analysis of patients in the age groups 50-59 years (n = 329) and 60-69 years (n = 648) who had a first-time isolated aortic valve replacement between 2000 and 2019. Kaplan-Meier and competing risk analyses were performed to compare survival, incidence of aortic valve reoperation, haemorrhagic complications and thromboembolic events for mechanical versus biological prostheses.
Patients aged 50-59 years with a biological prosthesis had a higher probability of aortic valve reintervention (26.3%, biological vs 2.6% mechanical; P < 0.001 at 15 years). The incidence of haemorrhagic complications or thromboembolic events was similar in the 2 groups. Patients aged 60-69 years with a mechanical prosthesis had a higher risk of haemorrhagic complications (6.9%, biological vs 16.2%, mechanical; P = 0.001 at 15 years). Biological prostheses had a higher overall probability of reintervention for valve dysfunction (20.9%, biological vs 4.8%, mechanical; P = 0.024). In both age groups, there was no difference in long-term survival between patients receiving a biological or a mechanical prosthesis.
There was no difference in long-term survival between mechanical and biological prostheses for both age groups. Mechanical prostheses had a higher risk of bleeding in the 60-69-year group whereas biological valves had higher overall reintervention probability without an impact on long-term survival. It may be safe to use biological valves based on lifestyle choices for patients in the 50-69-year age group.
50-69 岁患者使用生物假体或机械假体尚无共识。既往研究报道机械瓣膜具有生存优势。我们的目标是比较 50-59 岁和 60-69 岁中龄组患者接受机械或生物主动脉瓣假体的长期生存。
我们对 2000 年至 2019 年间首次接受孤立性主动脉瓣置换术的 50-59 岁（n=329）和 60-69 岁（n=648）患者进行回顾性分析。使用 Kaplan-Meier 和竞争风险分析比较机械与生物假体的生存、主动脉瓣再手术发生率、出血并发症和血栓栓塞事件。
50-59 岁生物假体组主动脉瓣再干预的可能性更高（26.3%，生物 vs 2.6%，机械；15 年时 P<0.001）。两组出血并发症或血栓栓塞事件发生率相似。60-69 岁机械假体组出血并发症风险较高（6.9%，生物 vs 16.2%，机械；15 年时 P=0.001）。生物假体整体因瓣膜功能障碍而再干预的可能性较高（20.9%，生物 vs 4.8%，机械；P=0.024）。在两个年龄组中，生物和机械假体患者的长期生存率均无差异。
两个年龄组中，机械和生物假体的长期生存率均无差异。机械假体在 60-69 岁年龄组出血风险较高，而生物瓣膜总体再干预概率较高，但不影响长期生存。50-69 岁年龄组患者可根据生活方式选择安全地使用生物瓣膜。
