Long-term outcomes of mechanical versus biological valve prosthesis in native mitral valve infective endocarditis

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2022-06-02 DOI:10.1080/14017431.2022.2079712

Markus Malmberg, V. Anttila, P. Rautava, J. Gunn, V. Kytö

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引用次数: 3

Abstract

Abstract Objectives. To study the long-term outcomes of mitral valve replacement with mechanical or biological valve prostheses in native mitral valve infective endocarditis patients. Desing. We conducted a retrospective, nationwide, multicenter cohort study with patients aged ≤70 years who were treated with mitral valve replacement for native mitral valve infective endocarditis in Finland between 2004 and 2017. Results. The endpoints were all-cause mortality, ischemic stroke, major bleeding, and mitral valve reoperations. The results were adjusted for baseline features (age, gender, comorbidities, history of drug abuse, concomitant surgeries, operational urgency, and surgical center). The median follow-up time was 6.1 years. The 12-year cumulative mortality rates were 36% for mechanical prostheses and 74% for biological prostheses (adj. HR 0.40; CI: 0.17–0.91; p = 0.03). At follow-up, the ischemic stroke had occurred in 19% of patients with mechanical prosthesis and 33% of those with a biological prosthesis (adj. p = 0.52). The major bleeding rates within the 12-year follow-up period were 30% for mechanical prosthesis and 13% for a biological prosthesis (adj. p = 0.29). The mitral valve reoperation rates were 13% for mechanical prosthesis and 12% for a biological prosthesis (adj. p = 0.50). Drug abuse history did not have a significant modifying impact on the results (interaction p = 0.51 for mortality and ≥0.13 for secondary outcomes). Conclusion. The use of mechanical mitral valve prosthesis is associated with lower long-term mortality compared to the biological prosthesis in non-elder native mitral valve infective endocarditis patients. The routine choice of biological mitral valve prostheses for this patient group is not supported by the results.

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机械瓣膜置换术与生物瓣膜置换术治疗先天性二尖瓣感染性心内膜炎的远期疗效比较

抽象的目标。目的探讨二尖瓣置换术与生物瓣膜置换术治疗先天性二尖瓣感染性心内膜炎的远期疗效。设计。我们对2004年至2017年在芬兰接受二尖瓣置换术治疗先天性二尖瓣感染性心内膜炎的年龄≤70岁的患者进行了一项回顾性、全国多中心队列研究。结果。终点是全因死亡率、缺血性卒中、大出血和二尖瓣再手术。根据基线特征(年龄、性别、合并症、药物滥用史、合并手术、手术紧急程度和手术中心)对结果进行了调整。中位随访时间为6.1年。机械假体的12年累积死亡率为36%，生物假体为74% (adj. HR 0.40;置信区间:0.17—-0.91;p = 0.03)。随访时，19%机械假体患者发生缺血性卒中，33%生物假体患者发生缺血性卒中(p = 0.52)。12年随访期间，机械假体的主要出血率为30%，生物假体为13% (p = 0.29)。机械假体二尖瓣再手术率为13%，生物假体二尖瓣再手术率为12% (p = 0.50)。药物滥用史对结果没有显著的改变作用(死亡率的相互作用p = 0.51，次要结局的相互作用p≥0.13)。结论。在非老年先天性二尖瓣感染性心内膜炎患者中，与生物假体相比，机械二尖瓣假体的使用具有较低的长期死亡率。该患者组常规选择生物二尖瓣假体的结果不支持。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.