Hsu Andrea R, Karnakoti Snigdha, Abdelhalim Ahmed T, Anderson Jason H, Jain C Charles, Miranda William R, Stephens Elizabeth H, Dearani Joseph A, Schaff Hartzell V, Connolly Heidi M, Egbe Alexander C
Mayo Medical School, Mayo Clinic, Rochester, MN, 55905, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
Int J Cardiol Congenit Heart Dis. 2025 Jun 3;21:100598. doi: 10.1016/j.ijcchd.2025.100598. eCollection 2025 Sep.
Bioprosthetic valves are frequently implanted in adults with congenital heart disease (CHD), but comprehensive data on bioprosthetic valve longevity and outcomes across all valve positions are lacking. The purpose of this study was to determine the incidence and risk factors for bioprosthetic valve dysfunction (BVD) across all valve positions in adults with CHD.
BVD was defined as Doppler mean gradient >40 mmHg and/or severe prosthetic/periprosthetic regurgitation for aortic or pulmonary bioprostheses, or Doppler mean gradient >10 mmHg and/or severe prosthetic/periprosthetic regurgitation for mitral or tricuspid bioprostheses.
There were 1221 adults with CHD that underwent implantation of a bioprosthetic valve (age 39 ± 16 years, males 617 [51 %]). At the time of valve implantation, 755 (62 %), 325 (27 %), 176 (14 %), and 21 (1.7 %) received a bioprosthetic valve in the pulmonary, tricuspid, aortic, and mitral positions, respectively. The 10-year cumulative incidence of BVD was 28 %, 36 %, 43 %, and 68 % for pulmonary, tricuspid, aortic, and mitral bioprosthetic valves, respectively (p < 0.001). Using the pulmonary valve position as the reference group, valve position (tricuspid [HR 1.26, 95 % CI 1.09-1.58), aortic [HR 1.64, 95 % CI 1.22-1.97], mitral [HR 2.01, 95 % CI 0.83-4.05]) were associated with higher risk of BVD. Younger age was associated higher risk of BVD (HR 0.95, 95 % CI 0.86-0.98 per 5-year increment).
These data support the existing evidence that left-sided bioprosthetic valves demonstrate reduced durability in young patients and should be included in counseling and clinical decision-making.
生物瓣膜常用于先天性心脏病（CHD）成人患者，但缺乏关于所有瓣膜位置生物瓣膜寿命和结局的全面数据。本研究的目的是确定CHD成人患者所有瓣膜位置生物瓣膜功能障碍（BVD）的发生率和危险因素。
BVD定义为主动脉或肺动脉生物瓣膜的多普勒平均压差>40 mmHg和/或严重的人工瓣膜/人工瓣膜周围反流，或二尖瓣或三尖瓣生物瓣膜的多普勒平均压差>10 mmHg和/或严重的人工瓣膜/人工瓣膜周围反流。
1221例CHD成人患者接受了生物瓣膜植入（年龄39±16岁，男性617例[51%]）。在瓣膜植入时，分别有755例（62%）、325例（27%）、176例（14%）和21例（1.7%）在肺动脉、三尖瓣、主动脉和二尖瓣位置接受了生物瓣膜。肺动脉、三尖瓣、主动脉和二尖瓣生物瓣膜的BVD 10年累积发生率分别为28%、36%、43%和68%（p<0.001）。以肺动脉瓣位置作为参照组，瓣膜位置（三尖瓣[HR 1.26，95%CI 1.09-1.58]、主动脉瓣[HR 1.64，95%CI 1.22-1.97]、二尖瓣[HR 2.01，95%CI 0.83-4.05]）与BVD风险较高相关。年龄较小与BVD风险较高相关（每增加5岁，HR 0.95，95%CI 0.86-0.98）。
这些数据支持现有证据，即左侧生物瓣膜在年轻患者中耐久性降低，应纳入咨询和临床决策中。
