Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Department of Public Health, University of Turku, Turku, Finland.
Scand Cardiovasc J. 2022 Dec;56(1):132-137. doi: 10.1080/14017431.2022.2079712.
. To study the long-term outcomes of mitral valve replacement with mechanical or biological valve prostheses in native mitral valve infective endocarditis patients. . We conducted a retrospective, nationwide, multicenter cohort study with patients aged ≤70 years who were treated with mitral valve replacement for native mitral valve infective endocarditis in Finland between 2004 and 2017. . The endpoints were all-cause mortality, ischemic stroke, major bleeding, and mitral valve reoperations. The results were adjusted for baseline features (age, gender, comorbidities, history of drug abuse, concomitant surgeries, operational urgency, and surgical center). The median follow-up time was 6.1 years. The 12-year cumulative mortality rates were 36% for mechanical prostheses and 74% for biological prostheses (adj. HR 0.40; CI: 0.17-0.91; = 0.03). At follow-up, the ischemic stroke had occurred in 19% of patients with mechanical prosthesis and 33% of those with a biological prosthesis (adj. = 0.52). The major bleeding rates within the 12-year follow-up period were 30% for mechanical prosthesis and 13% for a biological prosthesis (adj. = 0.29). The mitral valve reoperation rates were 13% for mechanical prosthesis and 12% for a biological prosthesis (adj. = 0.50). Drug abuse history did not have a significant modifying impact on the results (interaction = 0.51 for mortality and ≥0.13 for secondary outcomes). . The use of mechanical mitral valve prosthesis is associated with lower long-term mortality compared to the biological prosthesis in non-elder native mitral valve infective endocarditis patients. The routine choice of biological mitral valve prostheses for this patient group is not supported by the results.
. 研究在芬兰患有原发性二尖瓣感染性心内膜炎的患者中，使用机械或生物瓣膜置换二尖瓣的长期结果。. 我们进行了一项回顾性、全国性、多中心队列研究，纳入了 2004 年至 2017 年期间在芬兰因原发性二尖瓣感染性心内膜炎接受二尖瓣置换术治疗且年龄≤70 岁的患者。. 终点为全因死亡率、缺血性卒中和主要出血以及二尖瓣再次手术。结果根据基线特征（年龄、性别、合并症、药物滥用史、同时手术、手术紧急程度和手术中心）进行调整。中位随访时间为 6.1 年。12 年累计死亡率分别为机械瓣膜组 36%和生物瓣膜组 74%（调整后 HR 0.40；95%CI：0.17-0.91； = 0.03）。随访时，机械瓣膜组有 19%的患者发生缺血性卒中，生物瓣膜组有 33%（调整后 = 0.52）。12 年随访期间，机械瓣膜组的主要出血发生率为 30%，生物瓣膜组为 13%（调整后 = 0.29）。机械瓣膜组的二尖瓣再次手术率为 13%，生物瓣膜组为 12%（调整后 = 0.50）。药物滥用史对结果没有显著的修正作用（死亡率的交互作用 = 0.51，次要结局的交互作用≥0.13）。. 在非老年原发性二尖瓣感染性心内膜炎患者中，与生物瓣膜相比，机械二尖瓣瓣膜置换术的长期死亡率较低。结果不支持对该患者群体常规选择生物二尖瓣瓣膜。
