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50至65岁患者主动脉瓣置换生物瓣膜与机械瓣膜的长期生存率相似。

Bioprostheses and Mechanical Prostheses for Aortic Valve Replacement in Patients Aged 50 to 65 Years Offer Similar Long-Term Survival Rates.

作者信息

Toporcer Tomáš, Lukačín Štefan, Kraus Andrea, Homola Marián, Bereš Anton, Trebišovský Michal, Radótzy Denis, Rohn Vilém, Kolesár Adrián

机构信息

Department of Heart Surgery, East Slovak Institute for Cardiovascular Diseases and Medical Faculty of Pavol Jozef Šafárik University, 04001 Košice, Slovakia.

Institute of Mathematics and Statistics, Faculty of Science, Masaryk University, 602 00 Brno, Czech Republic.

出版信息

J Cardiovasc Dev Dis. 2025 Jan 26;12(2):44. doi: 10.3390/jcdd12020044.

DOI:10.3390/jcdd12020044
PMID:39997478
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11856024/
Abstract

BACKGROUND

Aortic valve replacement (AVR) is the definitive therapy for patients with severe aortic valve stenosis (AoS). The aim of this work is to compare the effect of a mechanical prosthesis (MP) and a bioprosthesis (BP) on the survival of patients aged 50-65 years after AVR.

METHODS

The retrospective analysis included 276 patients aged 50 to 65 years who had undergone isolated AVR for AoS; 161 patients were implanted with an MP and 115 with a BP. Patient survival, adjusted for age, gender and risk parameters affecting survival, was assessed. A subgroup analysis was performed on the 208 patients with a modern valve (prosthesis models that are no longer used in clinical practice were removed from the sample).

RESULTS

After adjusting for risk factors for overall survival as well as for age and sex, the implantation of an MP did not have a significant effect on overall survival in comparison to a BP, at a median follow-up of 10.3 years ( = 0.477). The size of the MP had no significant effect on overall survival either (HR: 1.29; 95%CI: 0.16-10.21; = 0.812). However, the indexed effective orifice area of the BP had a positive effect on overall survival (HR: 0.09; 95%CI: 0.01-0.78; = 0.029).

CONCLUSIONS

The estimated survival of patients aged between 50 and 65 years after implantation of a BP with a sufficiently large indexed effective orifice area may exceed that of patients with an MP.

摘要

背景

主动脉瓣置换术（AVR）是重度主动脉瓣狭窄（AoS）患者的确定性治疗方法。本研究的目的是比较机械瓣膜（MP）和生物瓣膜（BP）对50至65岁患者行AVR术后生存情况的影响。

方法

回顾性分析纳入了276例年龄在50至65岁之间因AoS接受单纯AVR的患者；161例患者植入了MP，115例植入了BP。评估了经年龄、性别和影响生存的风险参数校正后的患者生存率。对208例使用现代瓣膜的患者进行了亚组分析（样本中剔除了临床实践中不再使用的假体模型）。

结果

在对总生存的危险因素以及年龄和性别进行校正后，在中位随访10.3年时，与BP相比，MP植入对总生存没有显著影响（P = 0.477）。MP的尺寸对总生存也没有显著影响（HR：1.29；95%CI：0.16 - 10.21；P = 0.812）。然而，BP的指数化有效瓣口面积对总生存有积极影响（HR：0.09；95%CI：0.01 - 0.78；P = 0.029）。

结论

植入指数化有效瓣口面积足够大的BP后，50至65岁患者的估计生存率可能超过植入MP的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/2062f7ab0162/jcdd-12-00044-g006a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/9d00f3a48b51/jcdd-12-00044-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/62ea16c019d8/jcdd-12-00044-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/5d35863731c6/jcdd-12-00044-g003a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/faab1362641d/jcdd-12-00044-g004a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/d32fbc6263b8/jcdd-12-00044-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/2062f7ab0162/jcdd-12-00044-g006a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/9d00f3a48b51/jcdd-12-00044-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/62ea16c019d8/jcdd-12-00044-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/5d35863731c6/jcdd-12-00044-g003a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/faab1362641d/jcdd-12-00044-g004a.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/d32fbc6263b8/jcdd-12-00044-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70d3/11856024/2062f7ab0162/jcdd-12-00044-g006a.jpg

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Surgical aortic valve replacement in patients aged <50 years and the choice of the prosthesis used: revisiting of the established practice based on convincing evidence or upon 'comparing apples to oranges'?
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Clinical Impact of Patient-Prosthesis Mismatch After Aortic Valve Replacement With a Mechanical or Biological Prosthesis.主动脉瓣置换术后机械瓣或生物瓣患者-假体不匹配的临床影响。
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