Objective: To compare and discuss the mid-to-long-term outcomes of mitral valve repair (MVP) versus biological mitral valve replacement (bMVR) in patients aged 60 years and above with rheumatic mitral valve disease. Methods: This is a retrospective cohort study. A total of 765 patients aged 60 years and older, diagnosed with rheumatic mitral valve disease and who underwent MVP or bMVR at Beijing Anzhen Hospital from January 2010 to January 2023, were retrospectively included. Among them, 186 were male and 579 were female, with an age of (66.1±4.5) years (range: 60 to 82 years). Patients were divided into two groups based on the surgical method: the mitral valve repair group (MVP group, n=256) and the bioprosthetic mitral valve replacement group (bMVR group, n=509). A 1∶1 propensity score matching was performed using a caliper value of 0.2 based on preoperative data. Paired sample t-tests, χ² tests, or Fisher's exact tests were used for intergroup comparisons. Kaplan-Meier method was employed to plot survival curves and valve-related reoperation rate curves for both groups before and after matching, and Log-rank tests were used to compare the mid-to long-term survival rates and valve-related reoperation rates between the two groups. Results: A total of 765 patients who completed follow-up were ultimately included, with a follow-up period (M(IQR)) of 5.1(5.0) years (range: 1.0 to 12.9 years). After matching, each group consisted of 256 patients. The incidence of early postoperative atrial fibrillation (39.1% vs. 49.2%, χ2=4.95, P=0.026) and early mortality rates (2.0% vs. 6.2%, χ2=4.97, P=0.026) were lower in the MVP group. Unadjusted Kaplan-Meier analysis showed significantly higher 5-year and 10-year survival rates for the MVP group (92.54% vs. 83.02%, 86.22% vs. 70.19%, Log-rank:P=0.001). After adjustment with propensity scores, the Kaplan-Meier analysis still indicated higher 5-year and 10-year survival rates in the MVP group compared to the bMVR group (92.54% vs. 85.89%, 86.22% vs. 74.83%, Log-rank: P=0.024). There were no significant differences in the rates of valve-related reoperation between the two groups before and after matching (5-year and 10-year reoperation rates pre-matching: 1.75% vs. 0.57%, 5.39% vs. 7.54%, Log-rank:P=0.207; post-matching: 1.75% vs. 0, 5.39% vs. 9.27%, Log-rank:P=0.157). Conclusion: For patients aged 60 years and above with rheumatic mitral valve disease, mitral valve repair offers better mid-to-long-term survival compared to biological valve replacement.
目的： 探讨60岁及以上风湿性二尖瓣病变患者接受二尖瓣修复手术或生物瓣置换手术后的中远期效果。 方法： 本研究为回顾性队列研究。纳入2010年1月至2023年1月于首都医科大学附属北京安贞医院诊断为风湿性二尖瓣病变并接受二尖瓣修复或生物瓣置换的765例60岁及以上患者。男性186例，女性579例，年龄（66.1±4.5）岁（范围：60~82岁）。依据手术方式将患者分为二尖瓣修复组（MVP组，n=256）和二尖瓣生物瓣置换组（bMVR组，n=509），根据术前资料进行1∶1倾向性评分匹配，卡钳值为0.2。组间比较采用配对样本t检验，χ2检验或Fisher确切概率法。采用Kaplan-Meier法分别绘制匹配前后两组的生存曲线和瓣膜相关再手术率曲线，并使用Log-rank检验比较两组中远期生存率和瓣膜相关再手术率。 结果： 随访时间［M（IQR）］为5.1（5.0）年（范围：1.0~12.9年）。匹配后两组各256例，bMVR组的术后早期心房颤动发生率（39.1%比49.2%，χ2=4.95，P=0.026）和术后早期病死率（2.0%比6.2%，χ2=4.97，P=0.026）较MVP组低。倾向性评分匹配前的Kaplan-Meier分析显示，MVP组的5年和10年生存率更高（92.54%比83.02%，86.22%比70.19%，Log-rank检验：P=0.001）。倾向性评分匹配后MVP组的5年和10年生存率分别为92.54%和85.89%，bMVR组分别为86.22% 和74.83%，差异有统计学意义（Log-rank检验：P=0.024）。MVP组和bMVR组的5年和10年瓣膜相关再手术率在匹配前（1.75%比0.57 %，5.39%比7.54 %，Log-rank检验：P=0.207）。匹配后MVP组的5年和10年瓣膜相关再手术率分别为1.75%和0，bMVR组分别为5.39%和9.27%，差异无统计学意义（Log-rank检验：P=0.157）。 结论： 对于60岁及以上的风湿性二尖瓣病变患者，与生物瓣置换术治疗相比，二尖瓣修复术具有更好的中远期生存率。.