60～70岁患者二尖瓣机械瓣与生物瓣置换术后疗效的对比观察

Clinical performance of mechanical versus bioprosthetic valves in patients aged 60-70 years

目的比较分析60~70岁患者行二尖瓣机械瓣置换与生物瓣置换术后瓣膜相关并发症、再次手术率及死亡率的差异。方法回顾性分析2006年1月-至2014年12月在解放军总医院心血管外科行二尖瓣机械瓣置换的119例60~70岁患者及行二尖瓣生物瓣置换的181例同年龄段患者的病例资料,比较两组的手术死亡率、瓣膜相关病死率、并发症发生率及再次手术率的差异。结果机械瓣组患者6年生存率优于生物瓣组(P=0.033),但两组瓣膜相关病死率差异无统计学意义(P=0.277)。机械瓣置换术后并发症包括栓塞10例(8.4%)、出血6例(5.0%),生物瓣置换术后并发症包括栓塞9例(5.0%)、瓣膜结构性毁损4例(2.2%)、瓣膜非结构性功能失常2例(1.1%)、瓣膜血栓5例(2.8%)、出血1例(0.6%)、人工瓣心内膜炎2例(1.1%),总体的并发症发生率两组比较差异无统计学意义(P=0.318)。生物瓣组8年内再次手术3例(1.7%),机械瓣未发生再次手术,但组间比较差异无统计学意义(P=0.305)。结论 60~70岁年龄段患者行二尖瓣机械瓣或生物瓣置换术后6年的瓣膜相关病死率、并发症发生率及再次手术率无明显差异。

Objective To compare the mortality, valve-related morbidity and reoperation rate between mechanical prostheses and bioprostheses in patients aged 60 to 70 years. Methods The pre-operative characteristics of 119 patients who received mechanical prostheses and 181 those with bioprosthesis implantation in our department between January 2006 and December 2014 were analyzed, and their mortality, valve-related morbidity and reoperation rate were compared. Results Followup revealed mechanical prostheses had a lower all-cause mortality after mitral valve replacement than bioprostheses at 6 years after the operation （P=0.033）, but there was no statistical difference in valve-related mortality （P=0.277）. The complications after mechanical prosthesis replacement had embolism （8.4%） and bleeding （5.0%）, bioprosthesis＇ those consisted of structural valvular deterioration （2.2%）, nonstructural dysfunction （1.1%）, thrombosis （2.8%）, embolism （5.0%）, bleeding （0.6%） and operated valvular endocarditis （1.1%）. There was no statistically significant difference in total complication rate between the two groups （P=0.318）. Biological group had 3 patients receiving reoperation in 8 years, while there was no reoperation in the mechanical group, but without statistical group difference. Conclusion Patients aged 60-70 years old could have a similar valve-related mortality, morbidity and reoperation rate after mitral valve replacement between mechanical and biological valves.