不同类型人工心脏瓣膜在感染性心内膜炎合并瓣膜毁损患者中的应用比较

The Clinical Evaluation of Prosthetic Valve in Patients with Dysfunction Valve Endocarditis

目的比较不同人工瓣膜类型(人工生物瓣和人工机械瓣)对感染性心内膜炎合并瓣膜毁损患者围术期及术后远期临床结局的影响。方法回顾性分析2005年8月至2016年7月在四川大学华西医院行人工瓣膜置换术的患者的临床资料,纳入接受人工生物瓣置换的全部感染性心内膜炎合并瓣膜毁损的患者52例,平均年龄(47±18)岁,平均随访时间(6.2±3.8)年,按年龄±5岁、体质量指数±20%、病变瓣膜位置、男女比例、手术时间±1年等配对条件以1∶3频数匹配接受人工机械瓣置换的同类患者156例。比较分析人工生物瓣与机械瓣对感染性心内膜炎合并瓣膜毁损患者围术期及远期临床结局的影响。结果接受生物瓣置换及机械瓣置换患者的围术期死亡率分别为17.3%±2.2%和19.9%±1.8%(P=0.27)。两类患者术后10年生存率分别为56.1%±5.2%和61.2%±8.1%(P=0.58),术后10年无并发症生存率分别为75.0%±3.2%和82.3%±4.4%(P=0.29)。年龄≤60岁的感染性心内膜炎患者,人工生物瓣与机械瓣术后10年再手术率分别为41.4%±7.2%和30.5%±5.4%(P=0.02),而对年龄>60岁的感染性心内膜炎患者,人工生物瓣与机械瓣的术后10年再手术率分别为24.1%±8.5%和14.7%±5.7%(P=0.36)。结论人工瓣膜类型对感染性心内膜炎合并瓣膜毁损患者围术期死亡率及术后远期生存率无明显影响。人工机械瓣膜在年龄≤60岁感染性心内膜炎患者中术后远期再手术率相比人工生物瓣膜更低。

Objective To evaluate the outcomes of valve replacement of endocarditis using bioprothetic and mechanical valves.Methods This study comprised 52 patients [mean age（47±18）yr.,mean follow-up time（6.2±3.8）years]underwent valve endocarditis with bioprotheses,The control group were matched（3∶1）with156 patients of endocarditis underwent mechanical valves replacement using the following variables：age±5 yr.,body mass index（BMI）±20%,time of operation±1 year,replacement position and sex ratio.And evaluate the effects of using bioprothetic and mechanical valves on perioperative and long-term outcomes of valve replacement of endocarditis.Results The perioperative mortality of the patients receiving bioprothetic and mechanical valves were17.3%±2.2% and 19.9% ±1.8%,respectively,which was independent of valve type（P=0.27）.Long-term survival were 56.1%±5.2% and 61.2% ±8.1%,respectively（P=0.58）.Meanwhile,long-term complicationfree survival were 75.0%±3.2% and 82.3%±4.4%,respectively（P=0.29）.For the patients younger than or equal to 60 yr.,long-term reoperation rates for bioprothetic and mechanical valves were 41.4% ±7.2% and30.5%±5.4%（P=0.02）.For the patients older than 60 yr.,however,reoperation rates were 24.1% ±8.5%and 14.7%±5.7%（P=0.36）.Conclusion Perioperative mortality and long-term survival are independent to valve types in patients with endocarditis.Mechanical valve shows potential advantage compared with bioprothetic valve in the patients younger than 60-year-old.