生物人工瓣膜置换术治疗主动脉瓣和二尖瓣合并症

IF 1.9
Hong Rae Kim MD, PhD , Ha Eun Oh MD , Ho Jin Kim MD, PhD , Seon-Ok Kim MSc , Ye-Jee Kim PhD , Jung-Min Ahn MD, PhD , Joon Bum Kim MD, PhD , Dae-Hee Kim MD, PhD
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引用次数: 0

摘要

目的利用全国行政索赔数据库,比较牛心包和猪生物假体双瓣膜置换术(DVR)的临床效果。方法从韩国国民健康保险服务数据库中确定2003年至2018年期间接受生物假体DVR的成年患者(年龄≥40岁)。研究的结果是全因死亡率、心脏死亡率和瓣膜相关事件,包括再手术、心内膜炎、全身血栓栓塞和大出血的发生率。基线调整采用倾向评分匹配。使用竞争风险分析评估与时间相关的结果,死亡被认为是竞争风险。结果符合入选标准的889例患者中,牛心包瓣膜置换术608例(68.3%),猪心包瓣膜置换术281例(31.6%)。在匹配195对患者后,牛组和猪组在心血管死亡率、全因死亡率、血栓栓塞或大出血方面没有显著差异;然而,在竞争风险分析中,猪瓣膜患者再次手术的风险更高(校正风险比为2.08;95%可信区间为1.10-3.94)。调整后的亚组分析显示,无糖尿病且Charlson合并症指数较低的患者接受猪瓣膜手术的再手术风险较高。结论:这项关于DVR的全国性队列研究显示,生物假体瓣膜类型的选择与心血管死亡风险无关。然而,猪假体的使用与再手术的高风险显著相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bioprosthetic valve replacement for concomitant aortic and mitral positions

Objective

To compare the clinical outcomes of double-valve replacement (DVR) using bovine pericardial and porcine bioprostheses, using a nationwide administrative claims database.

Methods

Adult patients (age ≥40 years) who underwent bioprosthetic DVR between 2003 and 2018 were identified from the Korean National Health Insurance Service database. The outcomes of interest were all-cause mortality, cardiac mortality, and valve-related events, including the incidences of reoperation, endocarditis, systemic thromboembolism, and major bleeding. Baseline adjustment was performed using propensity score matching. Time-related outcomes were evaluated using a competing risk analysis, with death considered a competing risk.

Results

Among the 889 patients who met the inclusion criteria, 608 (68.3%) received a bovine pericardial valve and the other 281 (31.6%) received a porcine valve. After matching 195 pairs of patients, there were no significant differences in cardiovascular mortality, all-cause mortality, thromboembolism, or major bleeding between the bovine and porcine groups; however, patients with porcine valves had a higher risk of reoperation (adjusted hazard ratio, 2.08; 95% confidence interval, 1.10-3.94) in competing risk analyses. An adjusted subgroup analysis showed that patients without diabetes and a lower Charlson Comorbidity Index who received a porcine valve had a higher risk of reoperation.

Conclusions

This nationwide cohort study on DVR revealed that the choice of bioprosthetic valve type was not associated with the risk of cardiovascular mortality. However, the use of porcine prostheses was significantly associated with a higher risk of reoperation.
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