老年瓣膜性心脏病患者生物瓣与机械瓣置换术后早期和中期预后的对比研究
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摘要
目的:比较老年瓣膜性心脏病患者接受生物瓣与机械瓣置换术后的早、中期结果。方法:对2007-01-09至2010-12-22期间在阜外医院因瓣膜性心脏病接受人工瓣膜置换术的559例年龄大于60岁的老年患者(生物瓣组319例,机械瓣组240例)进行回顾性研究。用倾向性比分对两组患者进行匹配后,两组患者均192例,分析术后早期(30天)及中期平均随访时间(65.97±15.49)个月的心功能、生存率、再次住院率以及血栓与出血相关并发症发生率等。结果:两组患者术后30天内死亡率均为2.1%。两组患者在随访期间的全因性死亡率差异无统计学意义(13.6%vs 13.7%,P=0.98);两组患者的再次住院率的差异也无统计学意义(25.5%vs 35.9%,P=0.17)。两组患者中期生存率的差异无统计学意义(P=0.68);无血栓与出血(脑、内脏及外周血管缺血或出血,不包括皮下出血)生存率两组间差异亦无统计学意义(P=0.78)。结论:老年瓣膜性心脏病患者置入生物瓣和机械瓣的术后早、中期的生存率和再入院率无差异。
Objectives: To compare the short-term and mid-term outcomes of elderly patients(>60 years old) with valvular heart disease(VHD) underwent bioprosthetic or mechanical valve replacement. Methods: Between January 2007 and December 2010, 559 elderly patients underwent valve replacement in Fuwai Hospital, clinical data of these patients were analyzed retrospectively(319 cases with bioprostheses vs 240 cases with mechanical prostheses). After matching, data from 192 cases in each group were compared. Results: The mortality within 30 postoperative days were similar(2.1% in both groups). All-cause death during follow up was also similar between the two groups(13.6% vs 13.7%, P=0.98). There was no statistically significant difference on the hospital readmission rate between the two groups(25.5% vs 35.9%, P=0.17). No significant difference was found on thromboembolic and hemorrhagic events free survival between the two groups(144 cases vs 138 cases, P=0.78).Conclusions: Short-term and mid-term survival and readmission rate are similar for the elderly VHD patients receiving bioprosthetic or mechanical valve replacement.
Objectives: To compare the short-term and mid-term outcomes of elderly patients(>60 years old) with valvular heart disease(VHD) underwent bioprosthetic or mechanical valve replacement. Methods: Between January 2007 and December 2010, 559 elderly patients underwent valve replacement in Fuwai Hospital, clinical data of these patients were analyzed retrospectively(319 cases with bioprostheses vs 240 cases with mechanical prostheses). After matching, data from 192 cases in each group were compared. Results: The mortality within 30 postoperative days were similar(2.1% in both groups). All-cause death during follow up was also similar between the two groups(13.6% vs 13.7%, P=0.98). There was no statistically significant difference on the hospital readmission rate between the two groups(25.5% vs 35.9%, P=0.17). No significant difference was found on thromboembolic and hemorrhagic events free survival between the two groups(144 cases vs 138 cases, P=0.78).Conclusions: Short-term and mid-term survival and readmission rate are similar for the elderly VHD patients receiving bioprosthetic or mechanical valve replacement.
引文
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[11]Kassa B, Gueyffier F, Cucherat M, et al. Comparison of bioprosthesis and mechanical valves, a meta-analysis of randomized clinical trials[J]. Cardiovascular Surgery, 2000, 8(6):477-483.
[12]Stewart S. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study[J]. Heart, 2001, 86(5):516-521.
[13]乔韡华,董念国.生物瓣的使用存在年龄限制吗?[J].临床心血管病杂志, 2014(9):745-748. DOI:10. 13201/j. issn. 1001-1439. 2014. 09. 002.
[2]IungB,VahanianA.Epidemiologyofacquiredvalvularheart disease[J]. Can J Cardiol, 2014, 30(9):962-970. DOI:10. 1016/j. cjca.2014. 03. 022.
[3]王琳.社区老年人群退行性心脏瓣膜病的五年纵向研究[D].北京:中国人民解放军军医进修学院, 2011.
[4]Silaschi M, Chaubey S, Aldalati O, et al. Is mitral valve repair superior to mitral valve replacement in elderly patients? comparison of shortand long-term outcomes in a propensity-matched cohort[J]. J Am Heart Assoc, 2016, 5(8):e003605. DOI:10. 1161/JAHA. 116. 003605.
[5]Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease:a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines[J]. J Am Coll Cardiol, 2017, 70(2):252-289. DOI:10. 1016/j. jacc. 2017. 03. 011.
[6]Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease[J]. Eur Heart J, 2017, 38(36):2739-2791. DOI:10. 1093/eurheartj/ehx391.
[7]Chan V, Jamieson WR, Germann E, et al. Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement.[J]. J Thorac Cardiovasc Sur, 2006,131(6):1267-1273. DOI:10. 1016/j. jtcvs. 2005. 11. 052.
[8]Hammermeister K, Sethi GK, Henderson WG, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve:final report of the veterans affairs randomized trial[J]. J Am Coll Cardiol,2000, 36(4):1152-1158. DOI:10. 1016/S0735-1097(00)00834-2.
[9]Jamieson WE, Germann E, Fradet GJ, et al. Bioprostheses and mechanical prostheses predictors of performance[J]. Asian Cardiovasc Thorac Ann, 2000, 8(8):121-126. DOI:10. 1177/021849230000800207.
[10]Demirag M, Kirali K, Omeroglu SN, et al. Mechanical versus biological valve prosthesis in the mitral position:a 10-year follow up of St. Jude medical and biocor valves[J]. J Heart Valve Dis, 2001, 10(1):78-83.
[11]Kassa B, Gueyffier F, Cucherat M, et al. Comparison of bioprosthesis and mechanical valves, a meta-analysis of randomized clinical trials[J]. Cardiovascular Surgery, 2000, 8(6):477-483.
[12]Stewart S. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study[J]. Heart, 2001, 86(5):516-521.
[13]乔韡华,董念国.生物瓣的使用存在年龄限制吗?[J].临床心血管病杂志, 2014(9):745-748. DOI:10. 13201/j. issn. 1001-1439. 2014. 09. 002.