Lv Kai, Yang Sumin, Jin Can, Gan Naiyan, Zhu Yuxiang, Hu Haoyu, Sun Bingqi, Qureshi Athar M, Liu Zhigang
Department of Cardiac Surgery, The First People's Hospital of Yulin, Yulin, China.
Department of Cardiac Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
J Thorac Dis. 2024 Jun 30;16(6):3923-3931. doi: 10.21037/jtd-24-441. Epub 2024 Jun 28.
A bioprosthetic valve is recommended for women of childbearing age who require cardiac valve replacement in order to minimize the risk of blood clot formation. However, it should be noted that compared to mechanical valves, bioprosthetic valves have a shorter lifespan and a higher likelihood of requiring reoperation during follow-up. To assess the long-term postoperative results, including the incidence of structural valve deterioration (SVD) and other clinical outcomes, in female patients aged 50 years and younger who underwent BalMedic bovine pericardial bioprosthetic valve replacement, a multicenter retrospective study was implemented in China.
Between 2004 and 2015, a cohort of 86 female patients across three medical centers underwent the implantation of 97 bioprosthetic valves. The primary outcome measure was overall survival (OS), while the secondary outcome measures were preliminary evidence of reoperation, SVD incidence, and bioprosthetic valve-related complications.
In this cohort study, 21 patients (24.4%, 21/86) died, while 37 patients (43.0%, 37/86) underwent a second valve replacement. The OS rates at 5 and 10 years were 97.56% and 71.93%, respectively. Additionally, the reoperation-free rates at 5 and 10 years were 92.83% and 80.68%, respectively. Similarly, the rates of freedom from SVD at 5 and 10 years were 95.65% and 51.82%, respectively, and the average duration of bioprosthetic valve replacement in our study was 9.34±3.31 years.
Despite the recruitment of younger female patients of child-bearing age in our cohort, the OS, reoperation-free survival, and SVD-free rates of the BalMedic bovine pericardial bioprosthetic valve were not inferior to those of the other age groups in the study or those reported in the literature.
对于需要进行心脏瓣膜置换的育龄女性,推荐使用生物瓣膜,以尽量降低血栓形成的风险。然而,应当注意的是,与机械瓣膜相比,生物瓣膜的使用寿命较短,且在随访期间需要再次手术的可能性更高。为了评估年龄在50岁及以下接受BalMedic牛心包生物瓣膜置换术的女性患者的术后长期结果,包括结构性瓣膜退变(SVD)的发生率和其他临床结局,在中国开展了一项多中心回顾性研究。
2004年至2015年期间,来自三个医疗中心的86名女性患者队列接受了97个生物瓣膜的植入。主要结局指标是总生存率(OS),次要结局指标是再次手术的初步证据、SVD发生率和生物瓣膜相关并发症。
在这项队列研究中,21名患者(24.4%,21/86)死亡,37名患者(43.0%,37/86)接受了二次瓣膜置换。5年和10年的OS率分别为97.56%和71.93%。此外,5年和10年的无再次手术率分别为92.83%和80.68%。同样,5年和10年的无SVD率分别为95.65%和51.82%,本研究中生物瓣膜置换的平均持续时间为9.34±3.31年。
尽管我们的队列纳入了年龄较轻的育龄女性患者,但BalMedic牛心包生物瓣膜在总生存率、无再次手术生存率和无SVD率方面并不低于研究中的其他年龄组或文献报道的结果。