Department of Cardiovascular Surgery, Chiba University Hospital, Chiba City, Japan.
Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Ann Thorac Surg. 2023 Jul;116(1):61-67. doi: 10.1016/j.athoracsur.2022.12.037. Epub 2023 Jan 10.
Using the Japan National Clinical Database and additional data, this study is an analysis of long-term survival of dialysis-dependent patients who underwent aortic valve replacement (AVR).
Dialysis-dependent patients who underwent de novo AVR between 2010 and 2012 and who were registered in the database were included. Concomitant aortic surgery and transcatheter aortic valve replacement were excluded. Additional data on the underlying kidney disease, the duration of dialysis, and clinical outcomes were registered between October 29, 2019, and August 30, 2020. The primary outcome was all-cause mortality. The secondary outcomes were cerebral infarction, cerebral bleeding, gastrointestinal bleeding, and prosthetic valve failure.
After propensity score matching, 1016 cases (508 each in the bioprosthetic and mechanical valve groups) were matched. The median follow-up period was 3.29 years (interquartile range [IQR], 0.59 years, 6.25 years). The median survival time was 5.38 years (IQR, 1.20 and 9.26 years) in the mechanical valve group and 4.98 years (IQR, 1.69 and 9.62 years) in the bioprosthetic valve group. The Cox regression model showed no significant difference in long-term survival between the groups (mechanical valve: hazard ratio [HR], 0.895; 95% CI, 0.719-1.113; P = .318). The incidences of cerebral infarction and prosthetic valve failure requiring admission were similar between the groups. Cerebral bleeding (HR, 2.143; 95% CI, 1.125-4.080; P = .002) and gastrointestinal bleeding (HR, 2.071; 95% CI, 1.243-3.451; P = .0005) were more frequent in the mechanical valve group.
Long-term survival of dialysis-dependent patients was similar regardless of whether mechanical valves or bioprosthetic valves were implanted. The incidences of cerebral and gastrointestinal bleeding were 2-fold higher in the mechanical valve group.
本研究利用日本国家临床数据库和其他数据，分析了接受主动脉瓣置换术（AVR）的透析依赖患者的长期生存情况。
纳入数据库中 2010 年至 2012 年间接受首次 AVR 的透析依赖患者。排除同期主动脉手术和经导管主动脉瓣置换术。2019 年 10 月 29 日至 2020 年 8 月 30 日期间，登记了关于基础肾脏疾病、透析时间和临床结局的其他数据。主要结局为全因死亡率。次要结局为脑梗死、脑出血、胃肠道出血和人工瓣膜失功。
经倾向评分匹配后，1016 例患者（生物瓣组和机械瓣组各 508 例）匹配成功。中位随访时间为 3.29 年（四分位距[IQR]，0.59 年，6.25 年）。机械瓣组中位生存时间为 5.38 年（IQR，1.20 年和 9.26 年），生物瓣组为 4.98 年（IQR，1.69 年和 9.62 年）。Cox 回归模型显示两组间长期生存率无显著差异（机械瓣：风险比[HR]，0.895；95%CI，0.719-1.113；P=0.318）。两组间脑梗死和需要住院治疗的人工瓣膜失功发生率相似。机械瓣组脑出血（HR，2.143；95%CI，1.125-4.080；P=0.002）和胃肠道出血（HR，2.071；95%CI，1.243-3.451；P=0.0005）的发生率更高。
无论植入机械瓣还是生物瓣，透析依赖患者的长期生存率相似。机械瓣组脑卒中和胃肠道出血的发生率增加了 2 倍。
