Vicchio Mariano, Della Corte Alessandro, De Santo Luca Salvatore, De Feo Marisa, Caianiello Giuseppe, Scardone Michelangelo, Cotrufo Maurizio
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Ann Thorac Surg. 2008 Dec;86(6):1791-7. doi: 10.1016/j.athoracsur.2008.09.005.
Evaluation of the impact of prosthesis-patient mismatch (PPM) on long-term outcome and quality of life (QOL) in elderly patients who underwent implantation of small size bileaflet prostheses for aortic stenosis.
Between September 1988 and September 2006, 377 patients aged greater than 70 years underwent aortic valve replacement with a small size bileaflet prosthesis (17, 19, and 21 mm) in one Institution. The study population's survivors (345 patients) were divided into three groups according to the indexed effective orifice area (EOAI): Group A included patients with EOAI less than 0.60 cm(2)/m(2); group B included patients with EOAI ranging between 0.61 and 0.84 cm(2)/m(2); and group C included patients with EOAI 0.85 cm(2)/m(2) or greater. Cumulative and comparative analyses of long-term outcomes and of left ventricular mass regression were performed. The QOL was evaluated with the 36-Item Short Form Health Survey (SF-36) questionnaire.
Overall hospital mortality was 8.5% (32 patients). Group A included 33 patients (9.6%), group B 175 (50.7%), and group C 137 (39.7%). Actuarial survival was 88.8% +/- 0.016 at 1 year, 82.1% +/- 0.022 at 5 years, and 76.7% +/- 0.032 at 10 years. No difference emerged among the three groups. A significant reduction in left ventricular mass was observed in all groups and in all patient subsets of prosthetic size. The scores obtained in the SF-36 test were similar in the three groups and significantly higher than those of the general population (p < 0.001 in all domains).
Incidence of severe PPM is low after aortic valve replacement. Presence of severe or moderate PPM, did not influence long-term outcome, left ventricular mass regression and QOL in a population of septuagenarians.
评估人工瓣膜-患者不匹配（PPM）对接受小尺寸双叶人工瓣膜植入治疗主动脉瓣狭窄的老年患者长期预后和生活质量（QOL）的影响。
1988年9月至2006年9月期间，一家机构中377例年龄大于70岁的患者接受了小尺寸双叶人工瓣膜（17、19和21毫米）主动脉瓣置换术。根据体表面积校正的有效瓣口面积（EOAI），将研究人群中的幸存者（345例患者）分为三组：A组包括EOAI小于0.60平方厘米/平方米的患者；B组包括EOAI在0.61至0.84平方厘米/平方米之间的患者；C组包括EOAI为0.85平方厘米/平方米或更大的患者。进行了长期预后和左心室质量消退的累积及比较分析。使用36项简短健康调查（SF-36）问卷评估生活质量。
总体医院死亡率为8.5%（32例患者）。A组有33例患者（9.6%），B组175例（50.7%），C组137例（39.7%）。1年时精算生存率为88.8%±0.016，5年时为82.1%±0.022，10年时为76.7%±0.032。三组之间未出现差异。在所有组以及不同人工瓣膜尺寸的所有患者亚组中均观察到左心室质量显著降低。三组在SF-36测试中获得的分数相似，且显著高于一般人群（所有领域p<0.001）。
主动脉瓣置换术后严重PPM的发生率较低。在七十多岁的人群中，严重或中度PPM的存在并不影响长期预后、左心室质量消退和生活质量。
