Chang Chia-Jui, Chi Nai-Hsin, Wu Chung-Hsuen, Huang Ling-Ya, Lin Fang-Ju
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan.
Department of Pharmacy, National Taiwan University Cancer Center, Taipei City, Taiwan.
Heart. 2025 Jul 16. doi: 10.1136/heartjnl-2024-325648.
Current guidelines for aortic valve replacement (AVR) lack consensus on prosthesis selection in middle-aged patients. This study aimed to provide a comprehensive comparison of long-term outcomes following AVR with mechanical versus biological prostheses among middle-aged patients in an Asian population.
This retrospective cohort study used Taiwan's national claims database, including patients aged 45-64 years who underwent AVR between 2006 and 2021 across 46 hospitals. Propensity score matching was applied to achieve covariate balance. Risks of all-cause mortality and major adverse prosthesis-related events (major bleeding, ischaemic stroke, aortic valve reoperation, endocarditis and sudden cardiac death) were compared using restricted mean survival time (RMST) and subdistribution HRs (sHRs) to account for competing risks. Subgroup analyses were performed for patients aged 45-54 and 55-64 years.
A total of 1136 matched pairs of patients with biological or mechanical prostheses were included, with follow-up of up to 17 years. In the overall cohort, all-cause mortality did not significantly differ between prosthesis groups. However, patients with biological prostheses experienced fewer major adverse prosthesis-related events (10-year RMST difference: 0.68 years; 95% CI: 0.38 to 0.98; sHR: 0.69; 95% CI: 0.59 to 0.81). In age-stratified analyses, outcomes were comparable between types in patients aged 45-54, whereas biological prostheses were associated with similar survival but fewer adverse events in those aged 55-64.
Among middle-aged Asian patients undergoing AVR, biological and mechanical prostheses yield similar long-term survival, yet biological prostheses carry a lower risk of major adverse events, especially in those aged 55-64. Opting for biological prostheses at a younger age, potentially starting at age 55, may offer advantages in improving long-term outcomes.
目前主动脉瓣置换术（AVR）指南在中年患者的假体选择上缺乏共识。本研究旨在全面比较亚洲人群中年患者接受机械瓣膜与生物瓣膜AVR后的长期结局。
这项回顾性队列研究使用了台湾的国家索赔数据库，包括2006年至2021年期间在46家医院接受AVR的45至64岁患者。应用倾向评分匹配以实现协变量平衡。使用受限平均生存时间（RMST）和亚分布风险比（sHRs）比较全因死亡率和主要假体相关不良事件（大出血、缺血性中风、主动脉瓣再次手术、心内膜炎和心源性猝死）的风险，以考虑竞争风险。对45至54岁和55至64岁的患者进行亚组分析。
共纳入1136对生物瓣膜或机械瓣膜患者匹配对，随访时间长达17年。在整个队列中，各瓣膜组的全因死亡率无显著差异。然而，生物瓣膜患者发生的主要假体相关不良事件较少（10年RMST差异：0.68年；95%CI：0.38至0.98；sHR：0.69；95%CI：0.59至0.81）。在年龄分层分析中，45至54岁患者中两种瓣膜类型的结局相当，而生物瓣膜与55至64岁患者的生存相似，但不良事件较少。
在接受AVR的亚洲中年患者中，生物瓣膜和机械瓣膜的长期生存率相似，但生物瓣膜发生主要不良事件的风险较低，尤其是在55至64岁的患者中。在较年轻的年龄（可能从55岁开始）选择生物瓣膜可能有利于改善长期结局。
