Montero Juan Andres, Venturino Federica, Cubas Santiago, Rodríguez Sofía, Hernández Maximiliano, Sosa Carolina, Rodríguez Maximiliano, Brusich Daniel, Dayan Victor
Centro Cardiovascular Universitario, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
Interdiscip Cardiovasc Thorac Surg. 2025 May 6;40(5). doi: 10.1093/icvts/ivaf091.
The commonly accepted aortic valve prostheses have been either mechanical or biological. Each type has its advantages and disadvantages, with age being the most widely accepted variable to determine the best option. There is, however, a range between 60 and 70 years where an individualized approach is required.
This is a retrospective study. The primary outcome was overall survival based on the type of prosthesis used, stratified by effect modifiers. Association between prosthesis type and mortality rate was evaluated using the incidence rate ratio. Secondary outcomes included cardiovascular survival, postoperative mortality and complications, adjusted for age. Cox regression analysis was performed to account for confounders. Variation in the hazard ratio for death by age was explored by fitting a restricted cubic spline to the interaction between age and valve type. We included all adult patients who underwent surgical aortic valve replacement for severe stenosis in Uruguay from 2011 to 2021. A total of 3944 patients were enrolled; 1708 were females. Median follow-up time was 4.5 years.
Bioprostheses (BP) were associated with higher mortality in males and in patients without statins. When mortality rate was stratified by age, BP were associated with a higher risk in patients younger than 60 and a lower risk in the 70-79 age group.
BP are associated with worse survival in male patients and in the <60-year-old age group. Gender and statins should be considered when deciding the prosthesis for patients in the 60-69 age group. When the relative survival benefit of BP was analysed, 70 years was identified as the threshold at which their benefit became evident compared to mechanical prostheses.
目前普遍接受的主动脉瓣假体有机械瓣和生物瓣两种。每种类型都有其优缺点，年龄是决定最佳选择时最广泛接受的变量。然而，在60至70岁之间，需要采取个体化方法。
这是一项回顾性研究。主要结局是基于所使用的假体类型的总体生存率，并按效应修饰因素进行分层。使用发病率比评估假体类型与死亡率之间的关联。次要结局包括心血管生存率、术后死亡率和并发症，并对年龄进行了校正。进行Cox回归分析以考虑混杂因素。通过对年龄与瓣膜类型之间的相互作用拟合受限立方样条来探索死亡风险比随年龄的变化。我们纳入了2011年至2021年在乌拉圭因严重狭窄接受外科主动脉瓣置换术的所有成年患者。共纳入3944例患者；其中1708例为女性。中位随访时间为4.5年。
生物瓣（BP）与男性患者和未使用他汀类药物患者的较高死亡率相关。当按年龄对死亡率进行分层时，BP与60岁以下患者的较高风险以及70 - 79岁年龄组的较低风险相关。
BP与男性患者和60岁以下年龄组的较差生存率相关。在为60 - 69岁年龄组的患者决定假体时，应考虑性别和他汀类药物的使用情况。在分析BP的相对生存获益时，确定70岁为与机械瓣相比其获益变得明显的阈值。
