University of British Columbia, Vancouver, British Columbia, Canada.
Ann Thorac Surg. 2010 Jan;89(1):51-8; discussion 59. doi: 10.1016/j.athoracsur.2009.08.070.
The effect of prosthesis-patient mismatch on long-term survival after aortic valve replacement has received considerable attention but there remains controversy. This study was performed to determine the predictors of mortality after aortic valve replacement and influence of prosthesis-patient mismatch on survival.
Contemporary mechanical prostheses and bioprostheses were implanted in 3,343 patients with aortic valve replacement between 1982 and 2003. The mean age was 68.06 +/- 11.20 years (median 70.06; range, 19 to 94), and the mean follow-up was 6.18 +/- 4.96 years, for a total of 20,666 years of follow-up. Prosthesis-patient mismatch was classified by effective orifice area index categories: normal (> 0.85 cm(2)/m(2)), 1,547 (46.3%); mild-to-moderate (> 0.65 cm(2)/m(2) to < or = 0.85 cm(2)/m(2)), 1,584 (47.4%); and severe (< 0.65 cm(2)/m(2)), 212 (6.3%).
The predictors of overall mortality were age, age categorization, New York Heart Association functional class III/IV, concomitant coronary artery bypass graft surgery, prosthesis type, preoperative congestive heart failure, diabetes mellitus, renal failure, and chronic obstructive pulmonary disease. All categories of effective orifice area indexes were not predictive of overall mortality, late mortality, or early mortality. The 15-year overall survival was differentiated by effective orifice area index categories: 38.1% +/- 2.1%, 37.0% +/- 2.2%, and 22.1% +/- 6.5%, respectively, for the three categories. Survival adjusted for the covariates (effective orifice area index, age, basal mass index, and ejection fraction) determined no effect except severe effective orifice area index when adjusted for ejection fraction more than 50% (p = 0.049).
Prosthesis-patient mismatch is not a predictor of overall standard unadjusted mortality to 15 years after aortic valve replacement, regardless of the category of effective orifice area index.
人工心脏瓣膜置换术后人工瓣膜-患者不匹配对长期生存率的影响已受到广泛关注，但仍存在争议。本研究旨在确定人工心脏瓣膜置换术后死亡率的预测因素以及人工瓣膜-患者不匹配对生存率的影响。
1982 年至 2003 年间，共有 3343 例患者接受了机械人工瓣膜和生物人工瓣膜置换术。患者平均年龄为 68.06±11.20 岁（中位数 70.06 岁；范围 19-94 岁），平均随访时间为 6.18±4.96 年，总随访时间为 20666 年。人工瓣膜-患者不匹配通过有效瓣口面积指数分类：正常（>0.85cm2/m2），1547 例（46.3%）；轻度至中度（>0.65cm2/m2 至≤0.85cm2/m2），1584 例（47.4%）；严重（<0.65cm2/m2），212 例（6.3%）。
全因死亡率的预测因素为年龄、年龄分类、纽约心脏协会功能分级 III/IV 级、同期冠状动脉旁路移植术、瓣膜类型、术前充血性心力衰竭、糖尿病、肾功能衰竭和慢性阻塞性肺疾病。所有有效瓣口面积指数分类均不能预测全因死亡率、晚期死亡率或早期死亡率。有效瓣口面积指数分类的 15 年总生存率存在差异：分别为 38.1%±2.1%、37.0%±2.2%和 22.1%±6.5%。调整协变量（有效瓣口面积指数、年龄、基础质量指数和射血分数）后，除射血分数大于 50%时重度有效瓣口面积指数（p=0.049）外，无其他影响。
人工瓣膜-患者不匹配不是人工心脏瓣膜置换术后 15 年全因未调整死亡率的预测因素，无论有效瓣口面积指数分类如何。
