Kato Yasuyuki, Tsutsumi Yasushi, Kawai Takahiro, Goto Tomoyuki, Takahashi Yosuke, Ohashi Hirokazu
Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinbo, Fukui 910-0833, Japan.
Gen Thorac Cardiovasc Surg. 2008 Aug;56(8):397-403. doi: 10.1007/s11748-008-0261-8. Epub 2008 Aug 13.
Controversy still exists about the influence of prosthesis-patient mismatch on outcomes after aortic valve replacement in the elderly. Our aim was to evaluate the effect of prosthesis-patient mismatch on survival and the extent of left ventricular (LV) mass regression after aortic valve replacement for aortic stenosis in Japanese patients aged >or=65 years.
A total of 84 patients who underwent isolated aortic valve replacement for aortic stenosis between 1986 and 2006 were retrospectively analyzed. Patients were divided into two groups based on the definition of prosthesis-patient mismatch (indexed effective orifice area <or=0.85 cm(2)/m(2)), and long-term results were compared. The mean follow-up time was 4.5 +/- 4.5 years. In 49 patients, follow-up echocardiography was performed at least 6 months after surgery, and the extent of LV mass regression was analyzed according to the presence of a prosthesis-patient mismatch.
Eight years after surgery, there was no significant difference between patients with and without mismatch in terms of actuarial freedom from cardiac-related death (P = 0.159) or death from any valve-related events (P = 0.107). The postoperative transvalvular pressure gradients were not significantly different between the two groups, and significant absolute and relative LV mass regression were observed in both groups.
Although a moderate prosthesis-patient mismatch appeared to be tolerable, the criteria of prosthesis-patient mismatch may have to be reassessed for elderly Japanese patients.
关于人工瓣膜与患者不匹配对老年患者主动脉瓣置换术后结局的影响仍存在争议。我们的目的是评估人工瓣膜与患者不匹配对≥65岁日本患者主动脉瓣狭窄行主动脉瓣置换术后生存率及左心室（LV）质量消退程度的影响。
回顾性分析1986年至2006年间84例因主动脉瓣狭窄接受单纯主动脉瓣置换术的患者。根据人工瓣膜与患者不匹配的定义（指数化有效瓣口面积≤0.85 cm²/m²）将患者分为两组，并比较长期结果。平均随访时间为4.5±4.5年。49例患者术后至少6个月进行了超声心动图随访，并根据人工瓣膜与患者不匹配情况分析了LV质量消退程度。
术后8年，有或无不匹配的患者在无心脏相关死亡的精算生存率（P = 0.159）或任何瓣膜相关事件导致的死亡（P = 0.107）方面无显著差异。两组术后跨瓣压差无显著差异，两组均观察到显著的绝对和相对LV质量消退。
尽管中等程度的人工瓣膜与患者不匹配似乎是可耐受的，但对于老年日本患者，人工瓣膜与患者不匹配的标准可能需要重新评估。
