Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Ann Thorac Surg. 2023 Oct;116(4):751-757. doi: 10.1016/j.athoracsur.2023.05.038. Epub 2023 Jun 24.
Biologic prostheses are being increasingly used for aortic and mitral valve replacement (AVR and MVR). This study evaluated the long-term durability of bioprosthetic valves in the mitral and aortic positions, as no well-designed population-based studies have addressed this issue before.
Using Taiwan's National Health Insurance Research Database, we compared biologic valve durability in the mitral and aortic positions in patients hospitalized between 2001 and 2017, with reoperation as the primary outcome. Both between-subject and within-subject designs were used, and the propensity score matching cohort (1:1 ratio) was created for the former.
We identified a total of 10,308 patients, 5462 of whom received AVR, 3901 received MVR, and 945 received double valve replacement. Both AVR and MVR cohorts had 2259 patients after matching. During a mean follow-up of 4.2 years (range, 1 day to 17.9 years), the reoperation rate in the MVR cohort (3.5%) was higher than that in the AVR cohort (2.6%) (hazard ratio 1.41; 95% CI, 1.01-1.98). A higher risk of all-cause death was observed in the MVR cohort (36.5%) than in the AVR cohort (32.6%) (hazard ratio 1.21; 95% CI, 1.10-1.34). Among patients receiving double valve replacement with the same prosthesis type, valves implanted in the aortic position were considerably less likely to require reimplantation.
Bioprosthetic valve placement in the aortic position is associated with superior outcomes in terms of durability, long-term mortality, and perioperative morbidity. Developing novel interventions and enhancing valve durability would expand bioprosthesis use for valve replacement.
生物假体越来越多地用于主动脉瓣和二尖瓣置换术（AVR 和 MVR）。本研究评估了二尖瓣和主动脉瓣位置的生物假体瓣膜的长期耐久性，因为在此之前，尚无精心设计的基于人群的研究解决此问题。
使用台湾全民健康保险研究数据库，我们比较了 2001 年至 2017 年住院患者的二尖瓣和主动脉瓣位置的生物瓣膜耐久性，以再次手术为主要结局。使用了受试者间和受试者内设计，并为前者创建了倾向评分匹配队列（1:1 比例）。
我们共确定了 10308 例患者，其中 5462 例接受了 AVR，3901 例接受了 MVR，945 例接受了双瓣置换术。匹配后，AVR 和 MVR 队列均有 2259 例患者。在平均 4.2 年（范围为 1 天至 17.9 年）的随访期间，MVR 队列（3.5%）的再次手术率高于 AVR 队列（2.6%）（风险比 1.41；95%置信区间，1.01-1.98）。在 MVR 队列中观察到全因死亡率（36.5%）高于 AVR 队列（32.6%）（风险比 1.21；95%置信区间，1.10-1.34）。在接受同种假体类型双瓣置换术的患者中，植入主动脉瓣位置的瓣膜再次植入的可能性要低得多。
在主动脉瓣位置放置生物假体瓣膜与耐久性、长期死亡率和围手术期发病率方面的更好结果相关。开发新的干预措施并提高瓣膜耐久性将扩大生物假体在瓣膜置换中的应用。
