Yu Jun, Wang Wei
Department of Structural Heart Disease Centre, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 May 31;9:904958. doi: 10.3389/fcvm.2022.904958. eCollection 2022.
Rheumatic heart disease (RHD) is a critical problem in developing countries and is the cause of most of the cardiovascular adverse events in young people. In patients aged 50-70 years with RHD requiring mitral valve replacement (MVR), deciding between bioprosthetic and mechanical prosthetic valves remains controversial because few studies have defined the long-term outcomes.
1,691 Patients aged 50-70 years with RHD who received mechanical mitral valve replacement (MVRm) or bioprosthetic mitral valve replacement (MVRb) were retrospectively reviewed in Fuwai hospital from 2010 to 2014. Follow-up ended 31/12/2021; median duration was 8.0 years [interquartile range (IQR), 7.7-8.3 years]. Propensity score matching at a 1:1 ratio for 24 baseline features between MVRm and MVRb yielded 300 patient pairs. The primary late outcome was postoperative mid- to long-term all-cause mortality.
Ten-year survival after MVR was 63.4% in the MVRm group and 63.7% in the MVRb group (HR, 0.91; 95% CI, 0.69-1.21; = 0.528). The cumulative incidence of mitral valve reoperation was 0.0% in the MVRm group and 1.2% in the MVRb group (HR, 0.92; 95% CI, 0.69-1.21; = 0.530). The cumulative incidence of stroke was 5.5% in the MVRm group and 6.1% in the MVRb group (HR, 0.89; 95% CI, 0.67-1.18; = 0.430). The cumulative incidence of major bleeding events was 3.3% in the MVRm group and 3.4% in the MVRb group (HR, 0.92; 95% CI, 0.70-1.22; = 0.560).
In patients aged 50-70 years with RHD who underwent mitral valve replacement, there was no significant difference on survival, stroke, mitral valve reoperation and major bleeding events at 10 years. These findings suggest mechanical mitral valve replacement may be a more reasonable alternative in patients aged 50-70 years with rheumatic heart disease.
风湿性心脏病（RHD）在发展中国家是一个关键问题，并且是年轻人中大多数心血管不良事件的病因。在年龄为50 - 70岁需要进行二尖瓣置换术（MVR）的风湿性心脏病患者中，在生物瓣膜和机械瓣膜之间做出选择仍存在争议，因为很少有研究明确长期结果。
对2010年至2014年在阜外医院接受机械二尖瓣置换术（MVRm）或生物二尖瓣置换术（MVRb）的1691例年龄为50 - 70岁的风湿性心脏病患者进行回顾性研究。随访截至2021年12月31日；中位持续时间为8.0年[四分位间距（IQR），7.7 - 8.3年]。对MVRm组和MVRb组的24个基线特征按1:1比例进行倾向得分匹配，得到300对患者。主要晚期结局是术后中长期全因死亡率。
MVRm组二尖瓣置换术后10年生存率为63.4%，MVRb组为63.7%（HR，0.91；95%CI，0.69 - 1.21；P = 0.528）。MVRm组二尖瓣再次手术的累积发生率为0.0%，MVRb组为1.2%（HR，0.92；95%CI，0.69 - 1.21；P = 0.530）。MVRm组中风的累积发生率为5.5%，MVRb组为6.1%（HR，0.89；95%CI，0.67 - 1.18；P = 0.430）。MVRm组大出血事件的累积发生率为3.3%，MVRb组为3.4%（HR，0.92；95%CI，0.70 - 1.22；P = 0.560）。
在年龄为50 - 70岁接受二尖瓣置换术的风湿性心脏病患者中，10年时在生存率、中风、二尖瓣再次手术和大出血事件方面无显著差异。这些发现表明，对于年龄为50 - 70岁的风湿性心脏病患者，机械二尖瓣置换术可能是一种更合理的选择。
