Veres Gábor, Benke Kálmán, Stengl Roland, Weber Petra, Marina Ereva, Szabó Gábor, Karck Matthias
Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle (Saale), Germany.
Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary.
J Cardiovasc Dev Dis. 2022 Oct 6;9(10):339. doi: 10.3390/jcdd9100339.
Objectives: Balancing anticoagulation and reoperation risks determines prostheses choice (mechanical/biological) for mitral valve replacement. We aimed to re-evaluate the outcomes after biological versus mechanical mitral valve replacement. Methods: We compared long-term benefits and risks of mechanical and biological prostheses in 2056 patients (52% men, 48% women; 65.4 ± 12.1 years) who underwent mitral valve replacements between 1993−2017, in a retrospective single-centre study. Data sources included prospective institutional database, social registry, general practitioner data and follow-up questionnaire. Patients were stratified by age: < = 39 y (n = 82), 40−49 y (n = 164), 50−59 y (n = 335), 60−69 y (n = 593), 70−79 y (n = 743) and > = 80 y (n = 139). Long-term outcomes (mortality, reoperations, bleeding) were analysed. Results: Altogether, 1308 mechanical (53% men, 47% women; 61.5 ± 11.7 years) and 748 biological (50% men, 50% women; 72.3 ± 9.6 years) valves were implanted. The reason for valve replacement was stenosis in 162, insufficiency in 823 and combined in 323 cases for mechanical, while it was 46, 567 and 135 for biological valves, respectively. Overall cumulative survival was higher with mechanical prosthesis (mean: 139 ± 4 vs. 102 ± 5 months, 10 y: 55% vs. 33%, p < 0.0001). Subgroup analysis revealed higher survival among patients receiving mechanical prosthesis up to 60 years (< = 39 y p = 0.047, 40−49 y p < 0.0001, 50−59 y p = 0.001). In patients 60−69 years, overall survival did not differ; however, in survivors beyond 8 years, mechanical prosthesis showed improved survival (p = 0.014). While between 70−79 years survival was nearly identical, for above 80 years, patients had a higher survival with biological prosthesis (p = 0.014). Conclusion: The present data demonstrated a higher survival of mechanical prosthesis in a wide range of patients after mitral valve replacement.
平衡抗凝和再次手术风险决定了二尖瓣置换术所用人工瓣膜（机械瓣/生物瓣）的选择。我们旨在重新评估生物瓣与机械瓣二尖瓣置换术后的结局。方法：在一项回顾性单中心研究中，我们比较了1993年至2017年间接受二尖瓣置换术的2056例患者（男性占52%，女性占48%；年龄65.4±12.1岁）使用机械瓣和生物瓣的长期获益与风险。数据来源包括前瞻性机构数据库、社会登记处、全科医生数据和随访问卷。患者按年龄分层：≤39岁（n = 82）、40 - 49岁（n = 164）、50 - 59岁（n = 335）、60 - 69岁（n = 593）、70 - 79岁（n = 743）和≥80岁（n = 139）。分析长期结局（死亡率、再次手术、出血情况）。结果：共植入1308枚机械瓣（男性占53%，女性占47%；年龄61.5±11.7岁）和748枚生物瓣（男性占50%，女性占50%；年龄72.3±9.6岁）。机械瓣置换的原因是狭窄162例、关闭不全823例和二者合并323例，生物瓣置换的原因分别是狭窄46例、关闭不全567例和二者合并135例。机械瓣的总体累积生存率更高（平均：139±4个月对102±5个月，10年生存率：55%对33%，p<0.0001）。亚组分析显示，60岁及以下接受机械瓣置换的患者生存率更高（≤39岁，p = 0.047；40 - 49岁，p<0.0001；50 - 59岁，p = 0.001）。在60 - 69岁的患者中，总体生存率无差异；然而，在存活超过8年的患者中，机械瓣显示出更好的生存率（p = 0.014）。70 - 79岁之间的生存率几乎相同，80岁以上患者使用生物瓣生存率更高（p = 0.014）。结论：目前的数据表明二尖瓣置换术后在广泛的患者群体中机械瓣的生存率更高。
