Department of Paediatric Cardiac Surgery, Medical University, Poznan, Poland.
Kardiol Pol. 2009 Aug;67(8):865-73.
Combined aortic valve replacement and coronary revascularisation is becoming more frequent. Patient-prosthesis mismatch (PPM) as an additional risk factor may potentially affect the early and late outcome.
To evaluate the impact of PPM on early and mid-term clinical results including quality of life in patients undergoing combined surgical treatment of coronary artery disease and aortic valve defects.
Medical records of 309 consecutive patients referred for combined surgery were reviewed. Patients were divided into three groups according to the presence of moderate or severe PPM (defined by aortic valve effective orifice area index in the range 0.85-0.65 cm2/m2 and smaller than 0.65 cm2/m2, respectively) or absence of PPM. The demographic and perioperative data, and early and late survival, as well as quality of life (SF-36) were analysed.
The presence of severe PPM was found in 51 (16.5%) patients, whereas moderate PPM--in 153 (49.5%) patients. Patients from both PPM groups were significantly older than those without PPM. Subjects with severe PPM had higher weight and body mass index. They frequently had dyslipidaemia and both PPM groups received a biological valve more often than patients without PPM (94.1 and 77.1 vs. 19.1%, p<0.0001). There was no significant difference between all groups regarding early or late mortality. Advanced age, renal insufficiency and arrhythmia were predictors of early death. Late survival was determined only by number of postoperative complications in a Cox regression model. There was no difference in any components of the SF-36 survey between all groups.
PPM is a frequent phenomenon in older patients requiring aortic valve replacement and revascularisation. Severe PPM occurs rarely, predominantly in obese patients. However, its presence does not affect early and late survival or quality of life.
主动脉瓣置换和冠状动脉血运重建联合治疗的应用越来越广泛。作为一个额外的危险因素，患者-假体不匹配（PPM）可能会影响早期和晚期的结果。
评估 PPM 对接受冠状动脉疾病和主动脉瓣缺陷联合手术治疗的患者的早期和中期临床结果（包括生活质量）的影响。
回顾了 309 例连续接受联合手术的患者的病历。根据存在中度或重度 PPM（定义为主动脉瓣有效开口面积指数在 0.85-0.65 cm2/m2 范围内且小于 0.65 cm2/m2）或不存在 PPM，将患者分为三组。分析了人口统计学和围手术期数据，以及早期和晚期生存率，以及生活质量（SF-36）。
51 例（16.5%）患者存在严重 PPM，153 例（49.5%）患者存在中度 PPM。PPM 组患者明显比无 PPM 组患者年龄更大。严重 PPM 组的患者体重和体重指数更高。他们经常患有血脂异常，并且 PPM 两组患者比无 PPM 组患者更常接受生物瓣（94.1%和 77.1%比 19.1%，p<0.0001）。所有组之间在早期或晚期死亡率方面没有显著差异。在 Cox 回归模型中，早期死亡的预测因素是年龄较大、肾功能不全和心律失常。晚期生存仅由术后并发症的数量决定。在所有组之间，SF-36 调查的任何组成部分都没有差异。
PPM 在需要主动脉瓣置换和血运重建的老年患者中是一种常见现象。严重 PPM 很少发生，主要发生在肥胖患者中。然而，它的存在并不影响早期和晚期的生存率或生活质量。
