猪与心包生物假体的长期性能比较。

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Thoracic and Cardiovascular Surgeon Pub Date : 2025-02-05 DOI:10.1055/a-2505-8447
Amedeo Anselmi, Morgan Daniel, Marie Aymami, Celine Chabanne, Sebastien Rosier, Julien Mancini, Jean Philippe Verhoye
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引用次数: 0

摘要

背景:猪和心包生物假体在外科主动脉瓣置换术(SAVR)中的长期比较结果存在争议。关于当代设备之间直接比较评价的信息很少。我们比较了单中心系列(N=3,983例)的晚期和极晚期结果。方法:从前瞻性收集的数据库中,我们纳入了3983例目前使用的两种猪生物假体(猪组)或一种目前使用的心包生物假体(心包组)。我们用Kaplan-Meier法和竞争风险法(主要终点)评估了SVD(结构性瓣膜恶化)的长期自由度。我们区分了SVD和患者-假体不匹配(PPM)。次要终点为晚期生存、无瓣膜相关死亡率、无SVD再手术、无非结构性瓣膜功能障碍和无心内膜炎。结果:中位随访时间为10.4年(99.7%,32,219例患者/年)。猪组的总生存率显著较低(p=0.002),这与基线组间差异有关。10年时,猪组的SVD Kaplan-Meier自由度显著提高(98.0%±0.3比96.3%±0.8)(p=0.003)。10年时SVD的竞争风险自由度分别为98.6%±0.2和97.2%±0.6(猪组和心包组)(p=0.001)。猪组表现出较高的PPM率。结论:尽管与心包瓣膜相比,PPM的风险增加,在这个系列中,猪生物假体似乎在预防晚期(10 ~ 10年)SVD方面表现更好。另一方面,PPM可能会对10年以上的生存率产生负面影响。这些因素需要根据患者的预期寿命和临床情况考虑SAVR患者的瓣膜选择和手术策略。
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Comparison of Long-Term Performance of Porcine versus Pericardial Bioprostheses.

Background:  The long-term comparative results between porcine and pericardial bioprostheses for surgical aortic valve replacement (SAVR) are debated. Scarce information exists concerning direct comparative evaluation among contemporary devices. We compared late and very late results in a single center series (n = 3,983 cases).

Methods:  From a prospectively collected database we included 3,983 recipients of two current porcine bioprostheses (porcine group) or one current pericardial bioprosthesis (pericardial group). We evaluated the long-term freedom from structural valve deterioration (SVD) with both Kaplan-Meier and competing risk methods (primary endpoint). We distinguished between SVD and patient-prosthesis mismatch (PPM). Secondary endpoints were late survival, freedom from valve-related mortality, freedom from reoperation for SVD, freedom from nonstructural valve dysfunction (NSVD) and freedom from endocarditis.

Results:  Median follow-up was 10.4 years (99.7% complete, 32,219 patients/years). Overall survival was significantly lower in the porcine group (p = 0.002), related to baseline intergroup differences. At 10 years, Kaplan-Meier freedom from SVD was significantly better in the porcine group (98.0% ± 0.3 vs. 96.3% ± 0.8; p = 0.003). Competing risk freedom from SVD at 10 years was 98.6% ± 0.2 and 97.2% ± 0.6 (porcine and pericardial group, respectively; p = 0.001). The porcine group displayed a higher rate of PPM.

Conclusion:  Despite the augmented risk of PPM compared with pericardial valves, in this series porcine bioprostheses seem to perform better concerning protection from late (>10 years) SVD. Smaller valve sizes (19-21 mm) may negatively impact the SVD risk among porcine valves but not among pericardial valves. These elements need to be considered for valve choice and surgical strategy in SAVR candidates according to their life expectancy, clinical context, and annulus size.

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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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