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机械瓣或生物瓣在主动脉瓣或二尖瓣置换术中的使用比较
Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement


Andrew B. Goldstone ... 心脑血管疾病 • 2017.11.09
相关阅读
• 美国经导管二尖瓣修复术的结局 • 主动脉瓣与二尖瓣置换术时对机械瓣和生物瓣的选择 • 2017心脏瓣膜病治疗方案要点更新

摘要


背景

对接受主动脉瓣或二尖瓣置换术的患者,可以使用机械瓣或生物瓣。虽然证据支持有限,但生物瓣越来越受到推崇。

 

方法

在美国加利福尼亚州,从1996年至2013年,对采用机械瓣或生物瓣行初次主动脉瓣置换术或二尖瓣置换术的患者,我们将其进行逆概率加权,比较了两个队列的远期死亡率以及再次手术、卒中和出血的发生率。根据瓣膜位置(主动脉瓣vs. 二尖瓣),我们将患者分层至不同的年龄组。

 

结果

从1996年至2013年,对主动脉瓣和二尖瓣置换术而言,生物瓣的使用大幅度增加,对主动脉瓣置换术是从11.5%增加至51.6%,对二尖瓣置换术是从16.8%增加至53.7%。对主动脉瓣置换术而言,在45~54岁年龄段的患者中,与接受机械瓣相比,接受生物瓣的患者与显著升高的15年死亡率相关(第15年30.6% vs. 26.4%;风险比,1.23;95%置信区间[CI],1.02~1.48;P=0.03),但在55~64岁年龄段的患者中则无该差异。对二尖瓣置换术而言,在40~49岁年龄段(44.1% vs. 27.1%;风险比,1.88;95% CI,1.35~2.63;P<0.001)和50~69岁年龄段(50.0% vs. 45.3%;风险比,1.16;95% CI,1.04~1.30;P=0.01)的患者中,与接受机械瓣相比,接受生物瓣的患者与显著升高的死亡率相关。接受生物瓣患者的再次手术发生率显著高于接受机械瓣的患者。和接受生物瓣的患者相比,接受机械瓣的患者具有较高的出血累积发生率,并且在某些年龄组中具有较高的卒中累积发生率。

 

结论

与生物瓣相比,机械瓣相关远期死亡率方面的获益在接受二尖瓣置换术的患者中可持续至70岁,在接受主动脉瓣置换术的患者中可持续至55岁(由美国国立卫生研究院及美国医疗保健研究与质量局[Agency for Healthcare Research and Quality]资助)。





作者信息

Andrew B. Goldstone, M.D., Ph.D., Peter Chiu, M.D., Michael Baiocchi, Ph.D., Bharathi Lingala, Ph.D., William L. Patrick, M.D., Michael P. Fischbein, M.D., Ph.D., and Y. Joseph Woo, M.D.
From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA. Address reprint requests to Dr. Woo at the Department of Cardiothoracic Surgery, Stanford University, Falk Bldg., CV-235, 300 Pasteur Dr., Stanford, CA 94305-5407, or at joswoo@stanford.edu.

 

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