Faculty of Medicine, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
Faculty of Medicine, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
J Thorac Cardiovasc Surg. 2023 Sep;166(3):728-737.e13. doi: 10.1016/j.jtcvs.2022.01.016. Epub 2022 Jan 22.
The objectives of this study were to compare rates of mortality and reoperations for patients aged younger than 65 years who underwent surgical aortic valve replacement (AVR). AVR with a bioprosthetic valve (BV) is increasing among younger patients, however evidence to inform the choice between BV or mechanical valve is limited.
We performed a retrospective cohort study using linked hospital and mortality data from Australia, for 3969 AVR patients between 2003 and 2018. We compared outcomes for valves in inverse probability of treatment-weighted cohorts, stratified according to age (18-54 years; 55-64 years). We used weighted Cox regression models to estimate hazard ratios (HRs) and weighted cumulative incidence function for subdistribution hazards, for follow-up intervals: 0 to 10 and >10 to 15 years.
Among patients aged 55 to 64 years, there was no difference in mortality at 0 to 10 years. However, at >10 to 15 years, mortality was higher among BV recipients (HR, 1.56; 95% CI, 1.01-2.42). There was no difference among patients aged 18 to 54 years. Reoperation rates for patients aged 55 to 64 years did not differ according to valve type at 0 to 10 years, but were higher for BV than mechanical valve at >10 to 15 years (HR, 2.87; 95% CI, 1.69-4.86). For patients aged 18 to 54 years, reoperation rates were consistently higher for BV at both time intervals (HR, 2.54 [95% CI, 1.03-6.25] and HR, 4.48 [95% CI, 2.15-9.32], respectively).
Patients aged 55 to 64 years who received a BV had a higher risk of mortality beyond 10 years. Rates of reoperations were higher among patients implanted with a BV in the entire cohort. Further investigation of long-term outcomes among patients with a BV is necessary. Continuous long-term monitoring of BV technologies will ensure evidence-based decision-making and regulation.
本研究旨在比较年龄小于 65 岁的患者行主动脉瓣置换术（AVR）后死亡率和再次手术率，这些患者接受的是生物瓣（BV）或机械瓣。尽管越来越多的年轻患者选择接受 BV，但目前关于 BV 与机械瓣选择的证据有限。
我们使用来自澳大利亚的医院和死亡率的回顾性队列研究数据，对 2003 年至 2018 年的 3969 例 AVR 患者进行了研究。我们根据年龄（18-54 岁；55-64 岁），在逆概率治疗加权队列中比较了不同瓣膜的结果。我们使用加权 Cox 回归模型，估算了随访 0 至 10 年和 10 至 15 年的随访间隔的风险比（HR）和亚分布危险的加权累积发生率。
在 55-64 岁的患者中，0-10 年的死亡率无差异，但 10-15 年时，BV 组死亡率更高（HR，1.56；95%CI，1.01-2.42）。18-54 岁的患者中无差异。55-64 岁的患者，0-10 年时两种瓣膜类型的再次手术率无差异，但 10-15 年时，BV 组的再次手术率高于机械瓣（HR，2.87；95%CI，1.69-4.86）。18-54 岁的患者，两个时间间隔的 BV 再次手术率均更高（HR，2.54 [95%CI，1.03-6.25]和 HR，4.48 [95%CI，2.15-9.32]）。
55-64 岁接受 BV 的患者 10 年后死亡率更高。整个队列中，BV 组的再手术率更高。需要进一步研究 BV 患者的长期结果。对 BV 技术的持续长期监测将确保基于证据的决策和监管。
