50~69岁感染性心内膜炎手术，机械瓣可能更优！武汉协和医院董念国等分析湖北近700例患者数据

2020-06-09 朱朱中国循环杂志

zehuiwang

医生/ 护师

对于二尖瓣病变患者，欧洲心脏病学会（ESC）建议，65岁以下首选机械瓣进行手术，而70岁以上应优选生物瓣

武汉协和医院心血管外科王寅、董念国等对2002年~2018年湖北省各医院所有接受初次二尖瓣瓣膜置换术的50~69岁感染性心内膜炎患者进行回顾性分析后发现，植入机械瓣的患者术后15年生存率明显高于植入生物瓣的患者。

研究者指出，对于二尖瓣病变患者，欧洲心脏病学会（ESC）建议，65岁以下首选机械瓣进行手术，而70岁以上应优选生物瓣。

美国心脏协会（AHA）的建议也类似，但年龄范围稍不同：50岁以下患者应选择机械瓣，70岁以上也建议优选生物瓣。

而对于50~69岁之间的患者，指南建议应基于患者因素和个人意愿，个体化选择人工瓣膜。

研究者认为，该研究说明，对于50~69岁感染性心内膜炎患者，机械瓣可能是更合理的选择。

该研究显示，2002年~2018年在湖北省各医院首次行二尖瓣瓣膜置换术的50~69岁感染性心内膜炎患者一共有698例，期中562例植入机械瓣，136例植入生物瓣，其平均年龄分别为62.2岁和68.7岁。

该研究的中位随访期为8.7年，最长随访16.5年。

分析结果显示，在经倾向评分匹配的机械瓣组（369例）和生物瓣组（123例）中，15年生存率分别为80.6%和69.3%，机械瓣组的死亡风险较生物瓣组降低了45.4%。

两组患者术后30天死亡率相似（2.4% vs 1.6%）。

机械瓣组和生物瓣组的二尖瓣二次手术率分别为8.8%和21.4%，机械瓣组的二次手术风险明显降低74%。

另外，与生物瓣组相比，机械瓣组的人工瓣膜心内膜炎累积发生风险降低37.1%（5.6% vs 7.2%），两组的中风（12.9% vs 10.5%）和大出血（12.0% vs 6.75%）累积发生率无明显差异。

来源：Bioprosthetic vs Mechanical Mitral Valve Replacement for Infective Endocarditis in Patients Aged 50 to 69 Years. Clin Cardiol, 2020 Jun 4.

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2022-07-18 Doctoryangbai

机械瓣对于IE更获益啊

58 0
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2020-06-10 12498974m61暂无昵称

#内膜#

50 0
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2021-05-17 ms5000001455536924

学习了

71 0
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2020-12-28 chg121

#机械瓣#

49 0
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2021-03-08 yilong5287542

#患者数据#

62 0
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2021-01-31 charl1234575

#感染性#

48 0
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2020-06-11 zhaojie88

#心内膜炎#

74 0
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2020-06-11 12498636m49(暂无昵称)

#协和#

65 0
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2020-06-11 guguangxiang

#协和医院#

64 0

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50~69岁感染性心内膜炎手术，机械瓣可能更优！武汉协和医院董念国等分析湖北近700例患者数据

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