Tomšič Anton, Marin-Cuartas Mateo, De La Cuesta Manuela, Otto Wolfgang, Bräuchle Paul T, Pfannmüller Bettina, Kiefer Philipp, Misfeld Martin, Leontyev Sergey, Borger Michael A, Noack Thilo
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Ann Thorac Surg Short Rep. 2023 Dec 21;2(2):251-256. doi: 10.1016/j.atssr.2023.11.032. eCollection 2024 Jun.
Comparative studies of outcomes between different biological mitral valve prostheses are scarce. This study compares the late clinical results of valve replacement with the Epic and Mosaic bioprostheses.
Patients undergoing isolated elective mitral valve replacement (MVR) between 2005 and 2019 were eligible for inclusion. Primary outcomes were freedom from mitral valve reintervention and overall survival. Inverse probability of treatment weighting and competing risk analyses were performed.
MVR was performed in 247 (73.7%) patients with the Epic prosthesis and in 88 (26.3%) patients with the Mosaic prosthesis. The median follow-up was 3 (interquartile range, 0.20-5.64) years. At 10 years postoperative, the estimated survival rates were 86.1% (95% CI, 80.5%-91.9%) and 73.5% (95% CI, 60.6%-89.3%) for the Epic and Mosaic groups, respectively ( = .40). On inverse probability of treatment weighted analysis, no significant intergroup difference was found (hazard ratio, 1.20; 95% CI, 0.54-2.66; = .70]. At 10 years, the cumulative incidence functions of mitral valve reintervention with death as competing risk were 34.4% (95% CI, 32.7%-36.1%) and 17.6% (95% CI, 16.2%-18.9%) for the Epic and Mosaic groups, respectively. On multivariable Fine-Gray analysis, the type of implanted mitral valve prosthesis just failed to reach a statistically significant difference in mitral valve reintervention (hazard ratio, 0.43 for Mosaic valve; 95% CI, 0.18-1.06; = .067). Structural valve deterioration was an uncommon indication for reintervention in the first 10 years postoperative.
Clinical results of MVR with the Epic or Mosaic prosthesis are satisfactory. Our results suggest that the Mosaic bioprosthesis might offer better freedom from reintervention.
不同生物二尖瓣假体之间结局的比较研究较少。本研究比较了使用Epic和Mosaic生物假体进行瓣膜置换的晚期临床结果。
2005年至2019年间接受孤立性择期二尖瓣置换术（MVR）的患者符合纳入标准。主要结局是二尖瓣再次干预的自由度和总生存率。进行了治疗权重的逆概率分析和竞争风险分析。
247例（73.7%）患者使用Epic假体进行了MVR，88例（26.3%）患者使用Mosaic假体进行了MVR。中位随访时间为3（四分位间距，0.20 - 5.64）年。术后10年，Epic组和Mosaic组的估计生存率分别为86.1%（95%CI，80.5% - 91.9%）和73.5%（95%CI，60.6% - 89.3%）（P = 0.40）。在治疗权重的逆概率分析中，未发现组间有显著差异（风险比，1.20；95%CI，0.54 - 2.66；P = 0.70）。10年时，以死亡为竞争风险的二尖瓣再次干预的累积发病率函数在Epic组和Mosaic组分别为34.4%（95%CI，32.7% - 36.1%）和17.6%（95%CI，16.2% - 18.9%）。在多变量Fine - Gray分析中，植入的二尖瓣假体类型在二尖瓣再次干预方面仅未达到统计学显著差异（Mosaic瓣膜的风险比为0.43；95%CI，0.18 - 1.06；P = 0.067）。结构瓣膜退变是术后前10年再次干预的罕见指征。
使用Epic或Mosaic假体进行MVR的临床结果令人满意。我们的结果表明，Mosaic生物假体可能在再次干预自由度方面表现更好。
