Arafat Amr A, AlQattan Hussain, Zahra Ashraf, Alghamdi Rawan, Alghosoon Haneen, AlGhamdi Faisal, Alamro Sultan, Albackr Hanan, Ismail Huda, Adam Adam I, Algarni Khaled D, Albacker Turki B
Department of Adult Cardiac Surgery, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia.
Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
J Card Surg. 2022 Dec;37(12):4227-4233. doi: 10.1111/jocs.16881. Epub 2022 Aug 30.
The debate about the optimal mitral valve prosthesis continues. We aimed to compare the early and late outcomes, including stroke, bleeding, survival, and reoperation after isolated mitral valve replacement (MVR) using tissue versus mechanical valves.
This retrospective cohort study included 291 patients who had isolated MVR from 2005 to 2015. Patients were grouped into the tissue valve group (n = 140) and the mechanical valve group (n = 151).
There were no differences in duration of mechanical ventilation, hospital stay, and hospital mortality between groups. Fifteen patients required cardiac rehospitalization, nine in the tissue valve group, and six in the mechanical valve group (p = .44). Stroke occurred in nine patients, five with tissue valves, and four with mechanical valves (p = .66). Bleeding occurred in 22 patients, seven patients with tissue valves, and 15 patients with mechanical valves (p = .09). Freedom from reoperation was 95%, 93%, 84%, 67% at 3, 5, 7, and 10 years for tissue valve and 97%, 96%, 96%, and 93% for mechanical valves, respectively (p˂ .001). The median follow-up was 84 months (Q1: Q3: 38-139). Survival at 3, 5, 7, and 10 years was 94%, 91%, 89%, 86% in tissue valves and 96%, 93%, 91%, 91% in mechanical valves, respectively (p = .49).
Tissue valve degeneration is still an issue even in the new generations of mitral tissue valves. The significant risk of reoperation in patients with mitral tissue valves should be considered when using those valves in younger patients. Mechanical valves remain a valid option for all age groups.
关于最佳二尖瓣人工瓣膜的争论仍在继续。我们旨在比较使用生物瓣膜与机械瓣膜进行单纯二尖瓣置换术（MVR）后的早期和晚期结果，包括中风、出血、生存率和再次手术情况。
这项回顾性队列研究纳入了2005年至2015年期间接受单纯MVR的291例患者。患者被分为生物瓣膜组（n = 140）和机械瓣膜组（n = 151）。
两组之间的机械通气时间、住院时间和医院死亡率没有差异。15例患者需要再次住院治疗，生物瓣膜组9例，机械瓣膜组6例（p = 0.44）。9例患者发生中风，生物瓣膜组5例，机械瓣膜组4例（p = 0.66）。22例患者发生出血，生物瓣膜组7例，机械瓣膜组15例（p = 0.09）。生物瓣膜在3年、5年、7年和10年时再次手术的无复发生存率分别为95%、93%、84%、67%，机械瓣膜分别为97%、96%、96%和93%（p＜0.001）。中位随访时间为84个月（第一四分位数：第三四分位数：38 - 139）。生物瓣膜在3年、5年、7年和10年时的生存率分别为94%、91%、89%、86%，机械瓣膜分别为96%、93%、91%、91%（p = 0.49）。
即使在新一代二尖瓣生物瓣膜中，生物瓣膜退变仍然是一个问题。在年轻患者中使用二尖瓣生物瓣膜时，应考虑到患者再次手术的重大风险。机械瓣膜仍然是所有年龄组的有效选择。
