机械主动脉瓣置换术与生物人工主动脉瓣置换术在 50 至 70 岁患者中的应用。

Q4 Medicine Journal of Chest Surgery Pub Date : 2024-05-05 Epub Date: 2024-03-13 DOI:10.5090/jcs.23.143
Youngkwan Song, Ki Tae Kim, Soo Jin Park, Hong Rae Kim, Jae Suk Yoo, Pil Je Kang, Sung-Ho Jung, Cheol Hyun Chung, Joon Bum Kim, Ho Jin Kim
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引用次数: 0

摘要

背景:本研究比较了 50 岁至 70 岁主动脉瓣置换术(AVR)的疗效:本研究根据所用人工瓣膜的类型,比较了 50 至 70 岁患者主动脉瓣置换术(AVR)的疗效:我们对 2000 年 1 月至 2019 年 3 月期间在本院接受机械主动脉瓣置换术的患者与接受生物人工瓣膜置换术的患者进行了比较。比较采用了竞争风险分析法和基于倾向评分的反向治疗概率加权法(IPTW):共有 1,580 名患者(984 名患者接受了机械性 AVR;596 名患者接受了生物假体 AVR)入组。机械性 AVR 组和生物假体 AVR 组的早期死亡率无明显差异(0.9% 对 1.7%,P=0.177)。经 IPTW 调整后,生物假体 AVR 组的全因死亡风险明显高于机械 AVR 组(危险比 [HR],1.39;95% 置信区间 [CI],1.07-1.80;P=0.014)。竞争风险分析显示中风风险较低(亚分布危险比 [sHR],0.44;95% CI,0.28-0.67;p结论:在接受外科自体瓣膜置换术的 50 至 70 岁患者中,接受机械瓣膜置换术的患者比接受生物人工瓣膜置换术的患者生存率更高。机械瓣膜组发生中风和抗凝相关出血的风险较高,而生物瓣膜组发生房室再介入的风险较高。
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Mechanical versus Bioprosthetic Aortic Valve Replacement in Patients Aged 50 to 70 Years.

Background: This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used.

Methods: We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons.

Results: A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation- related bleeding (sHR, 0.35; 95% CI, 0.23-0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p<0.001).

Conclusion: Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.

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来源期刊
Journal of Chest Surgery
Journal of Chest Surgery Medicine-Surgery
CiteScore
0.80
自引率
0.00%
发文量
76
审稿时长
7 weeks
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