Weymann Alexander, Ali-Hasan-Al-Saegh Sadeq, Takemoto Sho, De Manna Nunzio Davide, Beneke Jan, Amanov Lukman, Ius Fabio, Stefan Ruemke, Schmack Bastian, Zubarevich Alina, Khalil Aburahma, Ruhparwar Arjang, Salman Jawad
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA.
J Clin Med. 2025 Sep 22;14(18):6666. doi: 10.3390/jcm14186666.
: Mitral valve replacement presents considerable challenges in the field of cardiothoracic surgery, particularly in patients aged 50 to 69, where the decision between bioprosthetic and mechanical valves is critical. Nevertheless, the optimal selection of prosthetic valves for candidates within this age-related gray zone remains inadequately defined, necessitating a thorough evaluation of long-term outcomes and associated risks. : This study aims to assess mid-term outcomes of MIMVR in patients aged 50 to 69, comparing reoperation rates, prosthesis-related morbidity, and overall survival between bioprosthetic and mechanical valves. While many prior studies on valve choice in patients aged 50 to 69 years are derived from sternotomy cohorts, the novelty of our work lies in the exclusive focus on patients undergoing minimally invasive techniques. : A retrospective analysis was conducted in accordance with the (STROBE) guidelines, including 172 patients aged 50-69 years who underwent minimally invasive mitral valve replacement via right minithoracotomy at a high-volume center in Germany between 2011 and 2023. Of the 172 patients, 95 underwent MIMVR using biological prostheses, while 77 received mechanical prostheses. Comprehensive data on demographics, surgical procedures, and postoperative complications, as well as long-term outcomes, were analyzed. : With a mean follow-up of 7.1 years, early outcomes revealed no significant differences in 30-day mortality (7.4% for bioprosthetic vs. 2.6% for mechanical; = 0.06). There was no significant differences in all-cause mortality at 1 year (8.4% vs. 3.9%; = 0.22), 3-year (9.5% vs. 7.8%; = 0.69), and 5-year (13.7% vs. 10.4%; = 0.19), or at the longest follow-up (13.7% vs. 10.4%; = 0.51). Kaplan-Meier analysis showed no significant difference in long-term survival between the groups ( = 0.5427). Postoperative arrhythmia occurred significantly more frequently in the biologic group compared to the mechanical group (18.9% vs. 6.5%; = 0.01). : For patients aged 50-69 undergoing MIMVR using a bioprosthetic or mechanical valve, the mid-term survival and incidence of reoperation and re-hospitalization were comparable up to 7 years. This provides evidence supporting the safe application of the MICS approach with either valve type in this gray-zone age group.
二尖瓣置换术在心胸外科领域面临着巨大挑战，尤其是对于年龄在50至69岁的患者，在生物瓣膜和机械瓣膜之间做出选择至关重要。然而，对于这个与年龄相关的灰色地带的候选人，人工瓣膜的最佳选择仍未得到充分明确，因此有必要对长期结果和相关风险进行全面评估。
本研究旨在评估年龄在50至69岁的患者进行微创二尖瓣置换术（MIMVR）的中期结果，比较生物瓣膜和机械瓣膜的再次手术率、假体相关发病率和总体生存率。虽然许多先前关于50至69岁患者瓣膜选择的研究来自胸骨切开术队列，但我们工作的新颖之处在于专门关注接受微创技术的患者。
根据（加强流行病学观察性研究报告标准）（STROBE）指南进行了一项回顾性分析，纳入了2011年至2023年期间在德国一家高容量中心通过右胸小切口接受微创二尖瓣置换术的172例年龄在50 - 69岁的患者。在这172例患者中，95例使用生物假体进行了MIMVR，而77例接受了机械假体。分析了关于人口统计学、手术程序、术后并发症以及长期结果的综合数据。
平均随访7.1年，早期结果显示30天死亡率无显著差异（生物瓣膜组为7.4%，机械瓣膜组为2.6%；P = 0.06）。1年（8.4%对3.9%；P = 0.22）、3年（9.5%对7.8%；P = 0.69）和5年（13.7%对10.4%；P = 0.19）以及最长随访期（13.7%对10.4%；P = 0.51）的全因死亡率均无显著差异。Kaplan - Meier分析显示两组之间的长期生存率无显著差异（P = 0.5427）。与机械瓣膜组相比，生物瓣膜组术后心律失常的发生率显著更高（18.9%对6.5%；P = 0.01）。
对于年龄在50 - 69岁接受生物瓣膜或机械瓣膜MIMVR的患者，中期生存率以及再次手术和再次住院的发生率在长达7年的时间内相当。这为在这个灰色地带年龄组中安全应用两种瓣膜类型的微创心脏手术（MICS）方法提供了证据支持。
