Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Heart Lung. 2025 Jan-Feb;69:87-93. doi: 10.1016/j.hrtlng.2024.09.016. Epub 2024 Oct 5.
Aortic valve disease(AVD) accounts for 33 % of valvular heart disease(VHD) but causes over 60 % of VHD mortality. For surgical AVR, mechanical valves are recommended for patients <50 years old and bioprosthetic valves for those >70 years old.
To investigate the long-term differences following AV replacement(AVR) comparing bioprosthetic and mechanical valves in patients aged 50-70.
4,927 patients underwent AVR, 744 of which were propensity-matched 2:1 for bioprosthetic and mechanical valves. Outcomes included mortality, morbidity, and rates of reoperation.
The average age of the propensity-matched groups was 57 and 56.7 years, and female sex accounted for 26.4 % and 25.0 % for the bioprosthetic and mechanical valve groups, respectively. Other baseline demographics and comorbidities were similar between the groups. There were no deaths at 30 days and complication rates did not differ between groups(p > 0.05). Mortality at 1, 5, and 15 years was similar between groups. Reoperation rates at 5 and 10 years did not significantly differ between bioprosthetic and mechanical valves(p = 0.84, p = 0.31), although at 15-year follow-up, patients with bioprosthetic valves were more likely to require reoperation(21.2 % versus 9.7 %, adjusted hazard ratio 3.65, 95 % confidence interval 1.07-12.5, p = 0.0.39).
Patients receiving AVR from 50 to 70 years old have similar long-term outcomes irrespective of whether they received bioprosthetic or mechanical valves, with only reoperation being significantly different at 15 years follow-up. With low rates of reoperation, mortality, and avoidance of anticoagulation, bioprosthetic valves are a reasonable option for patients 50-70 years old, although mechanical valves still provide a durability benefit for young patients.
主动脉瓣疾病（AVD）占瓣膜性心脏病（VHD）的 33％，但导致 60％以上的 VHD 死亡。对于外科 AVR，建议 50 岁以下的患者使用机械瓣膜，70 岁以上的患者使用生物瓣膜。
比较 50-70 岁患者行主动脉瓣置换术（AVR）后使用生物瓣膜和机械瓣膜的长期差异。
4927 例患者接受了 AVR，其中 744 例患者按倾向评分以 2:1 的比例匹配生物瓣膜和机械瓣膜。结果包括死亡率、发病率和再次手术率。
倾向评分匹配组的平均年龄分别为 57 岁和 56.7 岁，女性比例分别为生物瓣膜组 26.4％和机械瓣膜组 25.0％。两组的其他基线人口统计学和合并症相似。两组 30 天内均无死亡，并发症发生率无差异（p＞0.05）。两组 1、5 和 15 年的死亡率相似。5 年和 10 年的再次手术率在生物瓣膜和机械瓣膜之间无显著差异（p=0.84，p=0.31），尽管在 15 年随访时，生物瓣膜组患者更需要再次手术（21.2％对 9.7％，调整后的危险比 3.65，95％置信区间 1.07-12.5，p=0.039）。
50-70 岁接受 AVR 的患者无论接受生物瓣膜还是机械瓣膜，长期预后相似，只有在 15 年随访时再次手术有显著差异。由于再次手术率、死亡率低，且无需抗凝，生物瓣膜对于 50-70 岁的患者是合理的选择，尽管机械瓣膜仍为年轻患者提供了耐用性优势。
