Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Am J Cardiol. 2024 Sep 1;226:72-79. doi: 10.1016/j.amjcard.2024.07.004. Epub 2024 Jul 10.
Recommendations for prosthesis type in older patients who underwent surgical aortic valve replacement (SAVR) are established, albeit undervalidated. The purpose of this study is to compare outcomes after bioprosthetic versus mechanical SAVR across various age groups. This was a retrospective study using an institutional SAVR database. All patients who underwent isolated SAVR were compared across valve types and age strata (<65 years, 65 to 75 years, >75 years). Patients who underwent concomitant operations, aortic root interventions, or previous aortic valve replacement were excluded. Objective survival and aortic valve reinterventions were compared. Kaplan-Meier survival estimation and multivariate regression were performed. A total of 1,847 patients underwent SAVR from 2010 to 2023. A total of 1,452 patients (78.6%) received bioprosthetic valves, whereas 395 (21.4%) received mechanical valves. Of those who received bioprosthetic valves, 349 (24.0%) were aged <65 years, 627 (43.2%) were 65 to 75 years, and 476 (32.8%%) were older than 75 years. For patients who received mechanical valves, 308 (78.0%) were aged <65 years, 84 (21.3%) were between 65 and 75 years, and 3 (0.7%) were >75 years. The median follow-up in the total cohort was 6.2 (2.6 to 8.9) years. No statistically significant differences were observed in early-term Kaplan-Meier survival estimates between SAVR valve types in all age groups. However, the cumulative incidence estimates of aortic valve reintervention were significantly higher in patients aged under 65 years who received bioprosthetic than those who received mechanical valves, with 5-year reintervention rates of 5.8% and 3.1%, respectively (p = 0.002). On competing risk analysis for valve reintervention, bioprosthetic valves were significantly associated with an increased hazard of aortic valve reintervention (hazard ratio 3.35, 95% confidence interval 1.73 to 6.49, p <0.001). In conclusion, SAVR with bioprosthetic valves (particularly, in patients aged <65 years) was comparable in survival to mechanical valve SAVR but significantly associated with increased valve reintervention rates.
在接受主动脉瓣置换术（SAVR）的老年患者中，建议使用假体类型，尽管其验证不足。本研究的目的是比较不同年龄段生物假体与机械 SAVR 的结果。这是一项回顾性研究，使用机构 SAVR 数据库。比较了所有接受单纯 SAVR 的患者的瓣膜类型和年龄分层（<65 岁、65-75 岁、>75 岁）。排除了同时进行手术、主动脉根部干预或先前接受主动脉瓣置换的患者。比较了目标生存率和主动脉瓣再次干预。进行了 Kaplan-Meier 生存估计和多变量回归。2010 年至 2023 年期间，共有 1847 例患者接受了 SAVR。共有 1452 例（78.6%）患者接受了生物假体瓣膜，395 例（21.4%）患者接受了机械瓣膜。在接受生物假体瓣膜的患者中，349 例（24.0%）年龄<65 岁，627 例（43.2%）年龄 65-75 岁，476 例（32.8%）年龄>75 岁。对于接受机械瓣膜的患者，308 例（78.0%）年龄<65 岁，84 例（21.3%）年龄 65-75 岁，3 例（0.7%）年龄>75 岁。在总队列中，中位随访时间为 6.2（2.6 至 8.9）年。在所有年龄组中，SAVR 瓣膜类型的早期 Kaplan-Meier 生存估计没有统计学差异。然而，在接受生物假体的<65 岁患者中，主动脉瓣再次干预的累积发生率明显更高，5 年再干预率分别为 5.8%和 3.1%（p=0.002）。在主动脉瓣再次干预的竞争风险分析中，生物假体瓣膜与主动脉瓣再次干预的风险显著增加相关（危险比 3.35，95%置信区间 1.73 至 6.49，p<0.001）。总之，SAVR 采用生物假体瓣膜（特别是在<65 岁的患者中）的生存率与机械瓣膜 SAVR 相当，但与更高的瓣膜再干预率显著相关。
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