Cardiovascular Research Institute (CARIM), University of Maastricht, Maastricht, The Netherlands; Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham University Hospitals, Nottingham, United Kingdom.
Cardiovascular Research Institute (CARIM), University of Maastricht, Maastricht, The Netherlands; Department of Cardiology, "Pierangeli" Hospital, Pescara, Italy.
Am J Cardiol. 2024 Jun 15;221:64-73. doi: 10.1016/j.amjcard.2024.04.008. Epub 2024 Apr 16.
Bioprosthetic mitral valve replacement (bMVR) use is increasing; however, data regarding long-term durability are lacking. We sought to perform a reconstructed individual patient data meta-analysis from published Kaplan-Meier curves to ascertain survival, freedom from valve degeneration, and reoperation in studies published since 2010. We explored the effects of age and valve type (bovine pericardial or porcine valve) on outcomes. We searched MEDLINE, OVID, Embase, and Cochrane CENTRAL for studies reporting at least 3 years of follow-up after bMVR and published since 2010. The Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool was used to assess methodologic quality. Kaplan-Meier curves were digitized to extract individual patient data and reconstructed estimates for overall survival, freedom from structural valve deterioration (SVD), and freedom from reoperation. A total of 20 studies (16,465 patients) were included. A total of 9 studies reported on porcine valves, 6 reported on bovine, and 7 did not specify the valve type. The overall survival after bMVR at 15 years was 40% (confidence interval 38% to 42%), freedom from reoperation at 15 years was 79% (confidence interval 76% to 82%), and freedom from SVD at 15 years was 64% (58% to 70%). Freedom from SVD was improved in the 70+ years age group (93% up to 25 years, hazard ratio 6.6 [2.5 to 17] for 18 to 59 vs >70 years, p <0.0001). There was no difference in valve durability or survival between bovine pericardial or porcine valves. In this meta-analysis of patients who underwent bMVR using newer generation valves, the inverse relation between age and SVD was reiterated in the 70+ years age group. The prosthesis type made no difference in the outcomes.
生物瓣二尖瓣置换术（bMVR）的应用正在增加；然而，缺乏长期耐久性的数据。我们试图从已发表的 Kaplan-Meier 曲线中进行重建的个体患者数据荟萃分析，以确定自 2010 年以来发表的研究中患者的生存率、瓣膜退行性变的无失败率和再次手术率。我们探讨了年龄和瓣膜类型（牛心包或猪瓣膜）对结果的影响。我们在 MEDLINE、OVID、Embase 和 Cochrane CENTRAL 中搜索了至少报告 bMVR 后 3 年随访结果并自 2010 年以来发表的研究。使用非随机干预研究的风险偏倚（ROBINS-I）工具评估方法学质量。对 Kaplan-Meier 曲线进行数字化以提取个体患者数据并重建总体生存率、结构瓣膜退化（SVD）无失败率和无再次手术率的估计值。共纳入 20 项研究（16465 例患者）。共有 9 项研究报告了猪瓣膜，6 项研究报告了牛心包瓣膜，7 项研究未具体说明瓣膜类型。bMVR 后 15 年的总体生存率为 40%（置信区间 38%至 42%），15 年的无再次手术率为 79%（置信区间 76%至 82%），15 年的无 SVD 率为 64%（58%至 70%）。70 岁以上年龄组的 SVD 无失败率提高（25 年时 93%，18 至 59 岁与>70 岁相比，风险比为 6.6[2.5 至 17]，p<0.0001）。牛心包或猪瓣膜在瓣膜耐久性或生存率方面没有差异。在这项使用新一代瓣膜进行 bMVR 的患者荟萃分析中，70 岁以上年龄组中年龄与 SVD 之间的反比关系再次得到证实。假体类型对结果没有影响。
