Zhao Wei, Chen Zhongli, Chen Sipeng, Du Junzhe, Zhang Heng, Zhao Yan, He Li, Feng Wei, Sun Hansong, Zheng Zhe
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China.
Rev Cardiovasc Med. 2023 Sep 18;24(9):253. doi: 10.31083/j.rcm2409253. eCollection 2023 Sep.
The choice between bioprosthetic and mechanical valves for aortic valve replacement (AVR) and mitral valve replacement (MVR) among patients aged 50-70 years is controversial. We compared the long-term outcomes of patients using bioprosthetic or mechanical valves to provide clinical evidence for valve selection.
From 2002 to 2007, patients aged 50-70 years who underwent isolated AVR or MVR at the Fuwai Hospital were enrolled. After inverse probability-weighted (IPW) propensity balancing, we evaluated long-term mortality, stroke, and bleeding events between patients receiving mechanical and biological prostheses for MVR or AVR.
A total of 1639 patients were included in the study, including 1181 patients undergoing MVR (median follow-up: 11.6 years) and 458 patients undergoing AVR (median follow-up: 11.4 years). After IPW adjustment, there was no significant difference in long-term mortality and stroke rate between patients using bioprosthetic and mechanical valves for MVR [mortality: log-rank 0.802; stroke: log-rank 0.983] and AVR [mortality: log-rank 0.815; stroke: log-rank 0.537]. Landmark analysis at 12.5 years yielded significantly lower mortality in the patients receiving mechanical valves compared with bioprosthetic valves in the MVR cohort ( 0.028). Patients receiving mechanical aortic valves displayed an increased risk of bleeding compared with those who received bioprosthetic aortic valves [Hazard Ratio (95% Confidence interval): 2.51 (1.06-5.93) 0.036].
For patients aged 50-70, there was no significant difference in overall long-term mortality between mechanical and bioprosthetic valve recipients. Patients receiving mechanical valves for MVR displayed lower mortality after 12.5 years follow-up. For AVR, bioprosthetic valves were associated with a lower risk of bleeding.
对于年龄在50至70岁之间的患者，在主动脉瓣置换术（AVR）和二尖瓣置换术（MVR）中选择生物瓣膜还是机械瓣膜存在争议。我们比较了使用生物瓣膜或机械瓣膜患者的长期结局，以提供瓣膜选择的临床证据。
2002年至2007年，纳入在阜外医院接受单纯AVR或MVR的50至70岁患者。经过逆概率加权（IPW）倾向平衡后，我们评估了接受机械瓣膜和生物瓣膜进行MVR或AVR患者之间的长期死亡率、中风和出血事件。
共1639例患者纳入研究，其中1181例接受MVR（中位随访时间：11.6年），458例接受AVR（中位随访时间：11.4年）。经过IPW调整后，MVR [死亡率：对数秩检验P = 0.802；中风：对数秩检验P = 0.983]和AVR [死亡率：对数秩检验P = 0.815；中风：对数秩检验P = 0.537]中使用生物瓣膜和机械瓣膜的患者在长期死亡率和中风发生率上无显著差异。在12.5年进行的里程碑分析显示，MVR队列中接受机械瓣膜的患者死亡率显著低于接受生物瓣膜的患者（P = 0.028）。接受机械主动脉瓣的患者与接受生物主动脉瓣的患者相比，出血风险增加[风险比（95%置信区间）：2.51（1.06 - 5.93），P = 0.036]。
对于50至70岁的患者，机械瓣膜和生物瓣膜接受者的总体长期死亡率无显著差异。接受MVR的机械瓣膜患者在随访12.5年后死亡率较低。对于AVR，生物瓣膜出血风险较低。
