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대동맥판막 및 승모판막 치환술 시 판막유형 선택의 기준 연령 조사를 위한 국민건강보험공단 자료를 활용한 국가 코호트 연구

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Abstract
Background: Estimated life expectancy is the main determinant to select prosthetic types in heart valve replacement surgeries, with patient’s age being the only objectifiable figure that can be used as a reference-indicator, however, there still are not enough data to suggest optimal age-cutoffs. This study sought to explore the age-dependent survival-hazard functions of the prosthesis-type in aortic valve replacement (AVR) or/and mitral valve replacement (MVR) using a national administrative claims database.
Methods: From the Korean National Health Insurance Service database, the data of 24,374 patients who underwent AVR or/and MVR from 2003 to 2018 were retrieved (11993 AVR; 8911 MVR; 3470 AVR+MVR). In the inverse-probability-weighted cohort, an age-stratified analysis was conducted to compare the risk of mortality, reoperation, thromboembolism, and bleeding between mechanical and biologic prostheses.
Results: Following AVR, bio-prosthesis was associated with significantly greater risks of mortality than those of mechanical prosthesis in patients aged <55 years (adjusted hazard ratio [aHR], 2.18; P=0.002) and 55 to 64 years (aHR, 1.29; P=0.037), but the risk of mortality reversed in patients aged ≥65 years (aHR, 0.77; P=0.001). For MVR, the risk of mortality was also greater with bio-prosthesis in patients aged 55 to 69 years (aHR, 1.22; P=0.016), but there was no difference for patients ≥70 years (P=0.687). The risk of reoperation was consistently higher with bio-prosthesis regardless of valve position in all age strata; however, the risks of thromboembolism and bleeding were higher in elderly patients after mechanical AVR, with no differences after MVR in all age strata.
Conclusions: Compared to bioprosthetic valve replacement, the long-term survival benefit associated with a mechanical prosthesis persisted until 65 years of age in AVR, and 70 years in MVR.
Author(s)
옥유정
Issued Date
2022
Awarded Date
2022-08
Type
dissertation
Keyword
aortic valve replacementmitral valve replacementbiologic prosthesismechanical prosthesisage
URI
https://oak.ulsan.ac.kr/handle/2021.oak/9930
http://ulsan.dcollection.net/common/orgView/200000643559
Alternative Author(s)
YOU JUNG OK
Affiliation
울산대학교
Department
일반대학원 의학과
Advisor
김준범
Degree
Doctor
Publisher
울산대학교 일반대학원 의학과
Language
eng
Rights
울산대학교 논문은 저작권에 의해 보호 받습니다.
Appears in Collections:
Medicine > 2. Theses (Ph.D)
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