性别和年龄匹配的二尖瓣置换术后的长期结果：有二尖瓣环钙化vs无二尖瓣环钙化

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-05-01 DOI:10.1016/j.cjco.2025.02.011

Rosalind Groenewoud MD , Sorush Rokui MD , Byron H. Gottschalk MD , Defen Peng PhD , Nicholas Sinclair MD , Jian Ye MD

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引用次数: 0

摘要

背景：二尖瓣环钙化（MAC）预示着需要进行技术上具有挑战性的二尖瓣手术，并与二尖瓣置换术（MVR）后的不良预后相关。在年龄和性别匹配的队列中，没有研究比较MAC患者与非MAC患者的长期预后。方法：在2000年至2017年期间，共有67名接受MVR的MAC患者与其他病因无MAC的患者年龄和性别匹配1:3，形成268人的研究队列。采用扩展Cox回归模型研究MAC患者与其他二尖瓣病因患者的长期预后。结果两组年龄匹配(MAC， 70.5岁；非MAC， 70.4岁)和性别(MAC， 61.2%男性；非mac， 61.7%男性)。MAC不是1年死亡率的危险因素。1年后，MAC是降低生存率的独立危险因素(风险比2.781,95%可信区间1.642-4.709,P <；0.001)。MAC组的5年和10年生存率明显低于非MAC组(5年：51.0%±6.9% vs 74.6%±3.1%；10年：40.1%±8.0% vs 51.8%±4.1%,P <；0.001)。外周血管疾病是早期死亡率和长期生存率降低的唯一独立危险因素，慢性肾衰竭是1年死亡率的一个强大的独立危险因素。结论在年龄和性别匹配的队列中，MAC患者与无MAC患者相比，MVR后的早期结局相似，但长期生存率较差，这表明MVR可以安全地用于特定的MAC患者。MAC和PVD是降低长期生存率的独立危险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Long-Term Outcomes After Mitral Valve Replacement in Sex- and Age-Matched Patients With vs Without Mitral Annular Calcification

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Long-Term Outcomes After Mitral Valve Replacement in Sex- and Age-Matched Patients With vs Without Mitral Annular Calcification

Background

Mitral annular calcification (MAC) portends the need for a technically challenging mitral valve surgery and is associated with poor outcomes after mitral valve replacement (MVR). No study has compared long-term outcomes for patients with vs without MAC in age- and sex-matched cohorts.

Methods

Between 2000 and 2017, a total of 67 patients with MAC who underwent MVR were age- and sex-matched 1:3 with patients with other etiologies without MAC to create a study cohort of 268. An extended Cox regression model was used to investigate long-term outcomes of patients with MAC, compared to those with other mitral etiologies.

Results

The groups were matched for age (MAC, 70.5 years; non-MAC, 70.4 years) and sex (MAC, 61.2% male; non-MAC, 61.7% male). MAC was not a risk factor for 1-year mortality. After 1 year, MAC was an independent risk factor for reduced survival (hazard ratio 2.781, 95% confidence interval 1.642-4.709, P < 0.001). The 5-year and 10-year survival rates were significantly lower in the MAC group than they were in the non-MAC group (5-year: 51.0% ± 6.9% vs 74.6% ± 3.1%; 10-year: 40.1% ± 8.0% vs 51.8% ± 4.1%, P < 0.001). Peripheral vascular disease was the only independent risk factor for both early mortality and reduced long-term survival, and chronic renal failure was a strong independent risk factor for 1-year mortality.

Conclusions

In an age- and sex-matched cohort, patients with MAC have similar early outcomes, but poorer long-term survival following MVR, compared to those without MAC, suggesting that MVR can be performed safely in selected patients with MAC. MAC and PVD are independent risk factors for reduced long-term survival.

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