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

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.