50세이상 70세이하 환자에서 대동맥판막 치환수술시 기계판막 대 조직판막 비교

Abstract

Background This study aims to compare the outcomes of aortic valve replacement (AVR) according to the prosthetic valve type in patients aged between 50 and 70 years. Methods In the present study, patients, aged ranging from 50 to 70, who underwent mechanical AVR were compared with those who underwent bioprosthetic AVR, between January 2000 and March 2019. Competing risk analysis and inverse-probability-of-treatment-weighting (IPTW) method were used for comparisons. Results This study enrolled a total of 1580 patients (Mechanical AVR group, 984 patients; Bioprosthetic AVR group, 596 patients). There was no significant difference in early mortality between Mechanical AVR and Bioprosthetic AVR groups (0.9% versus 1.7%, p=0.177). After adjustment with the IPTW method, all-cause mortality in Bioprosthetic AVR group was higher than in Mechanical AVR group (hazard ratio[HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p = 0.014). Competing risk analysis revealed the risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation-related bleeding (sHR, 0.35; 95% CI, 0.23-0.52; p < 0.001) was higher in Mechanical AVR group. While the risk of reintervention was higher in Bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p < 0.001). Conclusion Among the patients aged 50 to 70 who underwent surgical AVR, the patients who received mechanical valves showed better survival than those who received bioprostheses. Mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding. While Bioprosthetic AVR group showed a higher risk of reintervention. Keywords: Aortic valve replacement, Middle-aged, Prosthetic valve, Mechanical valve, Bioprosthesis