Piperata Antonio, Mariani Carlo, Murana Giacomo, Fabbri Elio, Rucci Paola, Scuppa Maria Francesca, Londi Filippo, Bianco Edoardo, Guerrini Benedetta, Tammaro Ivan, Fabiani Ludovica, Careddu Margherita, Bellomare Marta, Snaidero Silvia, Nania Riccardo, Castagnini Sabrina, Di Carlo Marta, Orioli Valentina, Folesani Gianluca, Pacini Davide
Division of Cardiac Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy.
Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.
JTCVS Open. 2025 Jun 26;26:85-93. doi: 10.1016/j.xjon.2025.06.015. eCollection 2025 Aug.
To compare early and long-term clinical outcomes of bioprosthetic versus mechanical (On-X) mitral valve replacement (MVR) in patients aged 65 years and older.
This single-center retrospective study included consecutive patients equal to or older than 65 years underwent isolated MVR from 2005 to 2023. A propensity score-matched analysis was performed to compare early- and long-term clinical outcomes between patients with bioprostheses and mechanical On-X valve.
A total of 330 patients were included, of whom 232 (70.3%) experienced bioprosthetic mitral valve replacement (BMVR group) and 98 (29.7%) mechanical mitral valve replacement (MMVR group) with On-X prosthesis. Propensity score analysis allowed to match 98 patients from each group. In the matched cohorts, the overall survival at 1, 5, and 10 years was 97.7%, 86.5%, and 69.5% for the MMVR group and 89.6%, 80.8%, and 62.5% for the BMVR (log-rank test: 1.88, = .170). The 1-, 5-, and 10-year freedom from reoperation, endocarditis, pacemaker implantation, and hemorrhagic events were comparable between the 2 groups.
In patients older than 65 years requiring isolated MVR, the use of On-X mechanical prosthesis showed comparable long-term outcomes over bioprostheses.
比较65岁及以上患者生物瓣与机械瓣（On-X）二尖瓣置换术（MVR）的早期和长期临床结果。
这项单中心回顾性研究纳入了2005年至2023年期间连续接受单纯MVR且年龄在65岁及以上的患者。进行倾向评分匹配分析，以比较生物瓣和机械On-X瓣患者的早期和长期临床结果。
共纳入330例患者，其中232例（70.3%）接受生物瓣二尖瓣置换术（BMVR组），98例（29.7%）接受On-X机械瓣二尖瓣置换术（MMVR组）。倾向评分分析使每组匹配98例患者。在匹配队列中，MMVR组1年、5年和10年的总生存率分别为97.7%、86.5%和69.5%，BMVR组分别为89.6%、80.8%和62.5%（对数秩检验：1.88，P = 0.170）。两组在1年、5年和10年免于再次手术、心内膜炎、起搏器植入和出血事件的情况相当。
在年龄大于65岁需要单纯MVR的患者中，使用On-X机械瓣与生物瓣相比，长期结果相当。
