60~70岁患者主动脉机械瓣与生物瓣中期疗效对比  

Clinical performance of mechanical versus bioprosthetic valves for aortic valve replacement in patients age 60-70 years

作　　者：朱思明[1] 姜胜利[1] ZHU Si-ming;JIANG Sheng-li(Cardiovascular Department of First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心血管外科,北京市100853

出　　处：《中国心血管病研究》2021年第1期26-30,共5页Chinese Journal of Cardiovascular Research

基　　金：军委后勤保障部卫生局面上项目(16BJZ28)。

摘　　要：目的对比分析60~70岁患者行主动脉瓣机械瓣置换与生物瓣置换术后生存率、术后瓣膜并发症情况及再次手术率的差异。方法回顾性分析2005年1月至2015年12月在解放军总医院第一医学中心心血管外科行主动脉瓣机械瓣置换的64例60~70岁患者与同年龄段的147例行主动脉瓣生物瓣置换的患者的病例资料。根据术前基线资料,利用倾向性评分匹配方法对患者分组。分组后比较两组患者瓣膜置换术后的生存率、瓣膜相关病死率、瓣膜相关并发症发生率及再次手术率的差异。结果倾向性评分匹配后,机械瓣组与生物瓣组术后6年,两组患者的生存率及瓣膜相关病死率无统计学差异(P=0.160,P=1.000)。机械瓣组术后并发症包括机械瓣非结构性功能异常1例(2.1%),栓塞1例(2.1%)、出血1例(2.1%),生物瓣组术后并发症包括瓣膜血栓1例(2.1%)、栓塞4例(8.2%)。总体的并发症发生率两组无统计学差异(P=0.321)。生物瓣组6年内再次手术1例(2.1%),机械瓣组未发生再次手术,组间比较无统计学差异(P=1.000)。结论我中心60至70岁年龄段患者行主动脉瓣机械瓣或生物瓣置换术后6年的生存率、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 survival.valve-related morbidity and reoperation rate between mechanical prostheses and bioprostheses in patients age 60 to 70 years for aortic valve replacement.Methods The pre-operative characteristics of 211 patients who received aortic valve replacement with either a mechanical prostheses or a bioprosthesis between January 2005 and December 2015 in our department were reviewed.PSM method was used to select cases and compare their survival,valve-related mortality,morbidity and reoperation rate respectively.Results The follow-up revealed mechanical prostheses and bioprostheses had a equal survival and valve-related mortality rate after aortic valve replacement at 6 years(P=0.160,1.000).The valve-related morbidity of mechanical prostheses,made up by non-structural dysfunction(2.1%),embolism(2.1%)and bleeding(2.1%)was equal to bioprostheses(P=0.321)which consisted of valve thrombosis(2.1%)embolism(8.2%).The mechanical group had none reoperation in 6 years but there was 1 case in the bioprostheses group(P=1.000).Conclusion The patients,aged 60-70 years old.have a similar survival,valve-related mortality,morbidity as well as reoperation rate after aortic valve replacement cither with mechanical or biological valve at 6 years.

关 键 词：心脏瓣膜疾病 心脏外科手术 心脏瓣膜假体置入 手术后并发症 

分 类 号：R654.2[医药卫生—外科学]