Ramchandani Bunty, Sánchez Raúl, Rey Juvenal, Polo Luz, Gonzalez Álvaro, Lamas Maria-Jesús, Centella Tomasa, Díez Jesús, Aroca Ángel
Congenital Cardiovascular Surgery, Hospital Universitario La Paz, Madrid, Spain.
Congenital Cardiovascular Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Korean Circ J. 2022 Aug;52(8):623-631. doi: 10.4070/kcj.2021.0335. Epub 2022 Apr 21.
Pulmonary valve replacement (PVR) is the most common operation in adults with congenital heart disease (CHD). There is controversy regarding the best bioprosthesis. We compare the performance of stented bioprosthetic valves (the Mosaic [Medtronic™] porcine pericardial against Carpentier Perimount Magna Ease [Edwards™] bovine) in pulmonary position in patients with CHD.
Between January 1999 and December 2019, all the PVRs were identified from hospital databases in 2 congenital heart centres in Spain. Valve performance was evaluated using clinical and echocardiographic criteria. Propensity score matching was used to balance the 2 treatment groups.
Three hundred nineteen patients were retrospectively identified. After statistical adjustment, 79 propensity-matched pairs were available for comparison Freedom from reintervention for the porcine cohort was 98.3%, 96.1%, and 91.9% at 3, 5, and 10 years and 100%, 98%, and 90.8% for the bovine cohort (p=0.88). Freedom from structural valve degeneration (SVD) for the porcine cohort was 96.9%, 92.8% and 88.7% at 3, 5, and 10 years and 100%, 98%, and 79.1% for the bovine cohort (p=0.38). Bovine prosthesis was associated with a reintervention hazard ratio (HR), 1.12; 95% confidence intervals (CIs), 0.24-5.26; p=0.89 and SVD HR, 1.69 (0.52-5.58); p=0.38. In the first 5 years, there was no difference in outcomes. After 5 years, the recipients of the bovine bioprosthesis were at higher risk for SVD (reintervention HR, 2.08 [0.27-16.0]; p=0.49; SVD HR, 6.99 [1.23-39.8]; p=0.03).
Both bioprosthesis have similar outcomes up to 5 years, afterwards, porcine bioprosthesis seem to have less SVD.
肺动脉瓣置换术（PVR）是成人先天性心脏病（CHD）最常见的手术。关于最佳生物假体存在争议。我们比较了在CHD患者肺动脉位置植入的带支架生物假体瓣膜（美敦力公司的Mosaic猪心包瓣膜与爱德华兹公司的Carpentier Perimount Magna Ease牛心包瓣膜）的性能。
1999年1月至2019年12月期间，从西班牙2个先天性心脏病中心的医院数据库中识别出所有接受PVR的患者。使用临床和超声心动图标准评估瓣膜性能。采用倾向评分匹配法平衡两个治疗组。
回顾性识别出319例患者。经过统计调整后，有79对倾向评分匹配的患者可供比较。猪心包瓣膜组在3年、5年和10年时无需再次干预的比例分别为98.3%、96.1%和91.9%，牛心包瓣膜组分别为100%、98%和90.8%（p = 0.88）。猪心包瓣膜组在3年、5年和10年时无结构性瓣膜退变（SVD）的比例分别为96.9%、92.8%和88.7%，牛心包瓣膜组分别为100%、98%和79.1%（p = 0.38）。牛心包瓣膜再次干预的风险比（HR）为1.12；95%置信区间（CI）为0.24 - 5.26；p = 0.89，SVD的HR为1.69（0.52 - 5.58）；p = 0.38。在最初5年，两组结果无差异。5年后，接受牛心包生物瓣膜的患者发生SVD的风险更高（再次干预HR为2.08 [0.27 - 16.0]；p = 0.49；SVD HR为6.99 [1.23 - 39.8]；p = 0.03）。
两种生物瓣膜在5年内的结果相似，5年后，猪心包生物瓣膜似乎发生SVD的情况较少。
