40至65岁感染性心内膜炎患者行机械瓣与生物瓣主动脉瓣置换术后心内膜炎的生存及复发情况：来自INFECT注册研究的数据

Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry.

作者信息

Salsano Antonio, Di Mauro Michele, Labate Laura, Della Corte Alessandro, Lo Presti Federica, De Bonis Michele, Trumello Cinzia, Rinaldi Mauro, Cura Stura Erik, Actis Dato Guglielmo, Punta Giuseppe, Nicolini Francesco, Carino Davide, De Vincentiis Carlo, Garatti Andrea, Cappabianca Giangiuseppe, Musazzi Andrea, Cugola Diego, Merlo Maurizio, Pacini Davide, Folesani Gianluca, Sponga Sandro, Vendramin Igor, Pilozzi Casado Alberto, Rosato Francesco, Mikus Elisa, Savini Carlo, Onorati Francesco, Luciani Giovanni Battista, Scrofani Roberto, Epifani Francesco, Musumeci Francesco, Lio Antonio, Colli Andrea, Falcetta Giosuè, Nicolardi Salvatore, Zaccaria Salvatore, Vizzardi Enrico, Pantaleo Antonio, Minniti Giuseppe, Villa Emmanuel, Dalla Tomba Margherita, Pollari Francesco, Barili Fabio, Parolari Alessandro, Lorusso Roberto, Santini Francesco

机构信息

Division of Cardiac Surgery, Ospedale Policlinico San Martino, 16132 Genoa, Italy.

DISC Department, University of Genoa, 16126 Genoa, Italy.

出版信息

J Clin Med. 2023 Dec 27;13(1):153. doi: 10.3390/jcm13010153.

DOI:10.3390/jcm13010153

PMID:38202159

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10779833/

Abstract

BACKGROUND

Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years.

METHODS

This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test.

RESULTS

Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period ( < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322-0.926, = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077-0.933, = 0.039).

CONCLUSIONS

The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.

摘要

背景

感染性心内膜炎（IE）是一种严重疾病，在许多情况下需要进行手术。用于IE的主动脉瓣置换术（AVR）所植入假体的类型是否会影响患者生存率，这是一个存在争议的问题。本研究的目的是量化40至65岁患者中，根据假体类型，IE行AVR后的长期生存率及心内膜炎复发情况的差异。

方法

这是一项对INFECT注册研究的分析。通过应用筛法自抽样t检验来检测随时间推移机械假体与生物假体使用比例的趋势。使用最优完全匹配倾向评分对混杂因素进行调整。使用Cox模型比较总生存率的差异，而使用Gray检验评估心内膜炎复发的差异。

结果

总体而言，2000年至2021年期间，共有4365例患者被诊断为IE并接受手术。其中，549例年龄在40至65岁之间的患者接受了AVR。共有268例（48.8%）接受了机械假体，281例（51.2%）接受了生物假体。在研究期间，观察到机械假体与生物假体植入比例下降的显著趋势（<0.0001）。接受机械假体的患者长期生存率显著高于接受生物假体的患者（风险比[HR]0.546，95%置信区间：0.322 - 0.926，P = 0.025）。与生物假体相比，机械假体与AVR后心内膜炎复发显著减少相关（HR 0.268，95%置信区间：0.077 - 0.933，P = 0.039）。