Narayan Pradeep, Reeves Barnaby C, Rizvi Syad I A, Shokrollahi Kayvan, Ismail Huda, Angelini Gianni D, Nightingale Angus, Caputo Massimo
Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
Ann Thorac Surg. 2008 Dec;86(6):1799-803. doi: 10.1016/j.athoracsur.2008.08.019.
We sought to investigate the effect of patient prosthesis mismatch on hemodynamic profile using dobutamine stress echocardiography, and to evaluate midterm survival of patients undergoing aortic valve replacement with 19-mm Perimount (Baxter Healthcare, Santa Ana, California) aortic prosthetic valves.
Between December 1, 1999, and August 17, 2005, 147 patients (mean age, 76.8 +/- 5.51 years) had aortic valves replaced with 19-mm Perimount prostheses. Dobutamine stress echocardiography was performed in a subgroup of 24 patients (mean age, 76.6 +/- 5.60 years). Univariable predictors of peak transprosthetic gradient (PTG) under maximum stress, adjusted for resting PTG, were investigated by regression. Survival in the whole cohort was described, and univariable predictors of survival were investigated by Cox regression.
In the stress echocardiography subgroup, cardiac output (p < 0.0001), PTG (p < 0.0001), and effective orifice area index increased significantly (p = 0.002) under stress. Peak transprosthetic gradient under stress was strongly associated with PTG at rest (p < 0.0001). After controlling for PTG at rest, no other variables were associated with PTG under stress. In the whole cohort, mean duration of follow-up was 2.21 years; 23 patients died. Neither body surface area nor effective orifice area index was significantly associated with survival.
The 19-mm Perimount aortic prosthesis has acceptable hemodynamic performance. Transvalvular gradients were within a clinically acceptable range, both at rest and under stress. These findings suggest that patient-prosthesis mismatch is unlikely to cause a clinically important problem when the prosthesis is used, which is consistent with survival experience in the whole cohort.
我们试图通过多巴酚丁胺负荷超声心动图研究患者-人工瓣膜不匹配对血流动力学的影响，并评估接受19毫米Perimount（百特医疗保健公司，加利福尼亚州圣安娜）主动脉人工瓣膜置换术患者的中期生存率。
在1999年12月1日至2005年8月17日期间，147例患者（平均年龄76.8±5.51岁）接受了19毫米Perimount人工瓣膜置换主动脉瓣。对24例患者（平均年龄76.6±5.60岁）的亚组进行了多巴酚丁胺负荷超声心动图检查。通过回归分析研究在最大负荷下经人工瓣膜峰值梯度（PTG）的单变量预测因素，并对静息PTG进行校正。描述了整个队列的生存率，并通过Cox回归分析研究生存率的单变量预测因素。
在负荷超声心动图亚组中，负荷状态下的心输出量（p<0.0001）、PTG（p<0.0001）和有效瓣口面积指数显著增加（p=0.002）。负荷状态下的经人工瓣膜峰值梯度与静息时的PTG密切相关（p<0.0001）。在控制静息PTG后，没有其他变量与负荷状态下的PTG相关。在整个队列中，平均随访时间为2.21年；23例患者死亡。体表面积和有效瓣口面积指数均与生存率无显著相关性。
19毫米Perimount主动脉人工瓣膜具有可接受的血流动力学性能。跨瓣压差在静息和负荷状态下均在临床可接受范围内。这些发现表明，使用该人工瓣膜时患者-人工瓣膜不匹配不太可能引起临床上重要的问题，这与整个队列的生存经验一致。
