Sakamoto Yoshimasa, Hashimoto Kazuhiro, Okuyama Hiroshi, Takakura Hiromitsu, Ishii Shinichi, Taguchi Shingo, Kagawa Hiroshi
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
Ann Thorac Surg. 2006 Apr;81(4):1305-9. doi: 10.1016/j.athoracsur.2005.10.013.
It is still controversial as to whether a small prosthesis should be inserted or a small aortic annulus should be enlarged to minimize patient-prosthesis mismatch (PPM). This retrospective study reviewed our strategy for avoiding PPM.
Isolated or combined aortic valve replacement was performed in 181 patients, including 24 patients (13.3%) aged less than 65 years with a small aortic annulus (< or = 21 mm) who underwent enlargement of the annulus by the Manouguian (n = 18) or Nicks (n = 6) procedure. In patients aged 65 years or more, a Carpentier-Edwards Perimount pericardial (CEP) valve was implanted with few exceptions. We assessed our strategy for avoiding PPM by comparison with published normal reference values for the indexed effective orifice area.
A CEP valve was implanted in 53 patients, and St. Jude Medical (SJM) mechanical valves were used in 128 patients. A standard 21-mm SJM valve was only used in 4 patients and no 19-mm valves were employed. However, 19-mm CEP valves were used in 12 older patients with a small body surface area (1.43 +/- 0.14 m2). No patient receiving an SJM valve had an indexed effective orifice area of 0.85 cm2/m2 or less, and PPM developed in only 2 (3.8%) of 53 patients receiving CEP valves. Consequently, the prevalence of PPM was 1.1%. The 10-year survival rates of patients receiving CEP or SJM valves with or without annular enlargement were similar.
The prevalence of PPM was low in patients more than 65 years old with a relatively small body size who received bioprosthetic valves. In patients less than 65 years old with a small annulus, the method of first choice for avoiding PPM is aortic annular enlargement.
对于是应植入小号人工瓣膜还是扩大小主动脉瓣环以尽量减少患者-人工瓣膜不匹配（PPM）仍存在争议。这项回顾性研究评估了我们避免PPM的策略。
对181例患者进行了单纯或联合主动脉瓣置换术，其中包括24例（13.3%）年龄小于65岁且主动脉瓣环较小（≤21mm）的患者，他们通过马努吉安（n = 18）或尼克斯（n = 6）手术扩大了瓣环。65岁及以上的患者，除少数例外，均植入了卡朋蒂埃-爱德华兹心包（CEP）瓣膜。我们通过与已发表的指数化有效瓣口面积正常参考值进行比较，评估了我们避免PPM的策略。
53例患者植入了CEP瓣膜，128例患者使用了圣犹达医疗（SJM）机械瓣膜。标准的21mm SJM瓣膜仅用于4例患者，未使用19mm瓣膜。然而，12例体表面积较小（1.43±0.14m²）的老年患者使用了19mm CEP瓣膜。接受SJM瓣膜的患者中，没有患者的指数化有效瓣口面积小于或等于0.85cm²/m²，在接受CEP瓣膜治疗的53例患者中，只有2例（3.8%）出现了PPM。因此，PPM的发生率为1.1%。接受CEP或SJM瓣膜且有或无瓣环扩大的患者10年生存率相似。
对于年龄超过65岁、体型相对较小且接受生物瓣膜的患者，PPM的发生率较低。对于年龄小于65岁且瓣环较小的患者，避免PPM的首选方法是主动脉瓣环扩大术。
