Bioprosthetic Valve Positions in Patients With Atrial Fibrillation　- Insights From the BPV-AF Registry.

Circulation reports Pub Date : 2024-10-19 eCollection Date: 2024-11-08 DOI:10.1253/circrep.CR-24-0110

Yuki Obayashi, Makoto Miyake, Misa Takegami, Masashi Amano, Takeshi Kitai, Tomoyuki Fujita, Tadaaki Koyama, Hidekazu Tanaka, Kenji Ando, Tatsuhiko Komiya, Masaki Izumo, Hiroya Kawai, Kiyoyuki Eishi, Kiyoshi Yoshida, Takeshi Kimura, Ryuzo Nawada, Tomohiro Sakamoto, Yoshisato Shibata, Toshihiro Fukui, Kenji Minatoya, Kenichi Tsujita, Yasushi Sakata, Masayuki Fukuzawa, Kyokun Uehara, Toshihiro Tamura, Kunihiro Nishimura, Yutaka Furukawa, Chisato Izumi

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Abstract

Background: Data on the impact of valve position on clinical outcomes in patients with atrial fibrillation (AF) and bioprosthetic valves (BPVs) are limited.

Methods and results: The BPV-AF Registry was a multicenter, prospective, observational study involving 894 patients with BPVs and AF. In this post-hoc substudy, patients were classified according to BPV position: aortic (n=588; 65.8%), mitral (n=195; 21.8%), or both (n=111; 12.4%). The primary outcome was a composite of stroke/systemic embolism, major bleeding, heart failure requiring hospitalization, all-cause death, or BPV reoperation. During a mean follow up of 15.3±4.0 months, the primary outcome occurred in 90 (15.3%) patients (12.7/100 patient-years) in the aortic group, 25 (12.8%; 10.2/100 patient-years) in the mitral group, and 16 (14.4%; 11.8/100 patient-years) in the both-valves group (log-rank P=0.621). The unadjusted and adjusted risks were not significant for the mitral and both-valves groups relative to the aortic group (unadjusted hazard ratio [95% confidence interval] 0.80 [0.52-1.25] and 0.92 [0.54-1.57]; adjusted hazard ratio 0.89 [0.51-1.54] and 1.10 [0.58-2.09], respectively). There was no significant difference in the incidence of stroke/systemic embolism or major bleeding among the 3 groups (log-rank P=0.651 and 0.156, respectively).

Conclusions: In patients with BPVs and AF, the risk for the composite outcome was comparable regardless of the BPV position.

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心房颤动患者的生物人工瓣膜位置--来自 BPV-AF 登记的启示。

背景：有关瓣膜位置对心房颤动（房颤）和生物人工瓣膜（BPV）患者临床预后影响的数据十分有限：BPV-AF 登记是一项多中心、前瞻性、观察性研究，涉及 894 名 BPV 和房颤患者。在这项事后子研究中，根据 BPV 位置对患者进行了分类：主动脉（588 人；65.8%）、二尖瓣（195 人；21.8%）或两者（111 人；12.4%）。主要结果是中风/系统性栓塞、大出血、需要住院治疗的心力衰竭、全因死亡或 BPV 再次手术的综合结果。在平均 15.3±4.0 个月的随访期间，主动脉瓣组有 90 例（15.3%）患者（12.7/100 患者-年）、二尖瓣组有 25 例（12.8%；10.2/100 患者-年）、双瓣组有 16 例（14.4%；11.8/100 患者-年）出现主要结局（对数秩 P=0.621）。与主动脉瓣组相比，二尖瓣组和双瓣膜组的未调整风险和调整风险均无显著性差异（未调整风险比[95% 置信区间]分别为 0.80 [0.52-1.25] 和 0.92 [0.54-1.57]；调整风险比分别为 0.89 [0.51-1.54] 和 1.10 [0.58-2.09]）。3组患者的中风/系统性栓塞或大出血发生率无明显差异（对数秩P分别为0.651和0.156）：在BPV和房颤患者中，无论BPV位置如何，综合结果的风险都相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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