丹麦二尖瓣反流的二尖瓣手术趋势：1996年至2022年患者特征和死亡率的变化

IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

International journal of cardiology Pub Date : 2025-06-23 DOI:10.1016/j.ijcard.2025.133552

Liv Borum Schöps , Sofie Truong , Jeppe Petersen , Amna Alhakak , Morten Schou , Christian Lildal Carranza , Lars Køber , Emil Fosbøl , Lauge Østergaard

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引用次数: 0

摘要

背景/目的在严重的二尖瓣返流（MR）中推荐二尖瓣手术（MVS）。缺乏关于国家手术模式和患者特征的当代数据，这些数据对于疾病的持续流行病学监测至关重要。方法使用丹麦全国登记系统，确定1996年至2022年间接受MVS的MR患者。计算患者特征的时间趋势和每10万人年（PY）的年发病率。使用Kaplan-Meier估计和多变量校正cox分析分别计算一年累积死亡率和日历时间内的死亡率。结果共纳入8098例患者。中位年龄从65.5岁（1996-2001年）增加到69.4岁（2018-2022年）。患者在缺血性心脏病和心力衰竭方面的合并症减少。MVS的总发病率从4.09 /10万PY（1996-2022）上升到8.66/10万PY，二尖瓣修复、生物置换术和经导管边缘到边缘修复术（TEER）的发生率显著增加，机械置换术的发生率显著降低。1年累计总死亡率为：TEER 18.9%，生物置换术15.5%，机械置换术10.2%，二尖瓣修复术4.8%。校正分析显示，二尖瓣修复术后一年死亡率显著降低(HR 0.27 [95% CI 0.15-0.49], p <；0.001)和t (HR 0.55 (95% CI 0.31 - -0.97), p = 0.04)。其他干预措施没有观察到显著的死亡率差异。结论1996年至2022年，由于二尖瓣修复、生物置换和TEER发生率的增加，接受二尖瓣手术的患者越来越多。患者年龄增大，但主要心血管合并症较少。接受二尖瓣修复和TEER的患者死亡率随着时间的推移显著改善。结果可以反映早期诊断和增加超声心动图监测。

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Trends in mitral valve surgery for mitral valve regurgitation in Denmark: Changes in patient characteristics and mortality from 1996 to 2022

Background/Aims

Mitral valve surgery (MVS) is recommended in severe mitral valve regurgitation (MR). Contemporary data on national surgical patterns and patient characteristics are lacking and are essential for the continuous epidemiologic monitoring of the disease.

Methods

Using Danish nationwide registries, patients undergoing MVS for MR between 1996 and 2022 were identified. Temporal trends in patient characteristics and annual incidence rates per 100,000 person years (PY) were computed. One-year cumulative mortality and mortality rates over calendar time were computed using the Kaplan-Meier estimator and multivariable adjusted Cox-analysis respectively.

Results

8098 patients were included. Median age increased from 65.5 (1996–2001) to 69.4 years (2018–2022). Patients became less comorbid regarding ischemic heart disease and heart failure. The overall incidence rate of MVS increased from 4.09 to 8.66/100,000 PY (1996–2022), with significantly increasing incidences of mitral repair, biological replacement, and transcatheter-edge-to-edge repair (TEER), and significantly decreased incidence of mechanical replacement. The overall cumulative one-year mortalities were: TEER 18.9 %, biological replacement 15.5 %, mechanical replacement 10.2 %, mitral repair 4.8 %. Adjusted analysis showed a significant decrease in one-year mortality across time for mitral repair (HR 0.27 [95 % CI 0.15–0.49], p < 0.001) and TEER (HR 0.55 [95 % CI 0.31–0.97], p = 0.04). No significant mortality differences were observed for other interventions.

Conclusions

From 1996 to 2022, more patients underwent mitral valve surgery driven by increasing incidence rates of mitral repair, biological replacement, and TEER. Patients got older but less comorbid regarding major cardiovascular comorbidities. Mortality significantly improved over time for patients undergoing mitral repair and TEER. Results could reflect earlier diagnosis and increased echocardiographic surveillance.

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来源期刊

International journal of cardiology 医学-心血管系统

CiteScore

6.80

自引率

5.70%

发文量

758

审稿时长

44 days

期刊介绍： The International Journal of Cardiology is devoted to cardiology in the broadest sense. Both basic research and clinical papers can be submitted. The journal serves the interest of both practicing clinicians and researchers. In addition to original papers, we are launching a range of new manuscript types, including Consensus and Position Papers, Systematic Reviews, Meta-analyses, and Short communications. Case reports are no longer acceptable. Controversial techniques, issues on health policy and social medicine are discussed and serve as useful tools for encouraging debate.