Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Ann Thorac Surg. 2010 Jan;89(1):60-4. doi: 10.1016/j.athoracsur.2009.07.037.
Data suggest that patient-prosthesis mismatch (PPM) adversely effects late survival after aortic valve replacement (AVR). This study examined the incidence and implications of PPM in patients undergoing isolated AVR.
Prospectively collected data on patients undergoing isolated AVR for aortic stenosis between January 1, 1997 and December 31, 2007 were analyzed. The projected effective valve orifice area from in vivo data was indexed to body surface area (EOAi). PPM was defined as moderate for EOAi of < or = 0.85 cm(2)/m(2) and severe if < or = 0.6 cm(2)/m(2). The reference group comprised patients with EOAi > 0.85 cm(2)/m(2). The effect of PPM on postoperative survival was assessed by multivariate analysis.
Of 801 patients, PPM was severe in 48 (6.0%), moderate in 462 (57.8%), and nonexistent in 291 (36.4%). Mismatch was associated with increasing age and female gender, thus resulting in an increase in the EuroSCORE (reference group, 4.9 +/- 2.6; moderate PPM, 5.8 +/- 2.4; and severe PPM, 6.1+/-2.1; p < 0.001). PPM did not significantly increase hospital mortality. Four deaths occurred in the reference group (1.4%), 12 in the moderate PPM (2.6%), and none in the severe PPM group (p = 0.311). The 5-year survival estimates were 83% in reference, 86% in moderate PPM, and 89% in severe PPM (p = 0.25). By multivariate analysis, PPM was not an independent risk factor for reduced in-hospital or late survival.
Moderate PPM is common in patients undergoing AVR for aortic stenosis, but severe mismatch is rare. Patients with PPM have similar early and late postoperative survival rate.
数据表明，人工瓣膜-患者不匹配（PPM）会对主动脉瓣置换（AVR）后的晚期生存产生不利影响。本研究旨在探讨孤立性 AVR 患者中 PPM 的发生率及其影响。
分析了 1997 年 1 月 1 日至 2007 年 12 月 31 日期间接受单纯主动脉瓣狭窄 AVR 的患者的前瞻性采集数据。从体内数据预测的有效瓣口面积与体表面积（EOAi）相关。PPM 定义为中度 EOAi <或=0.85cm²/m²，重度为 <或=0.6cm²/m²。参考组为 EOAi>0.85cm²/m²的患者。通过多变量分析评估 PPM 对术后生存的影响。
在 801 例患者中，48 例（6.0%）为重度 PPM，462 例（57.8%）为中度 PPM，291 例（36.4%）为无 PPM。不匹配与年龄增加和女性性别有关，导致 EuroSCORE 增加（参考组，4.9 ± 2.6；中度 PPM，5.8 ± 2.4；重度 PPM，6.1±2.1；p<0.001）。PPM 并未显著增加住院死亡率。参考组发生 4 例死亡（1.4%），中度 PPM 组发生 12 例（2.6%），重度 PPM 组无死亡（p=0.311）。5 年生存率分别为参考组 83%、中度 PPM 组 86%和重度 PPM 组 89%（p=0.25）。多变量分析显示，PPM 不是住院或晚期生存时间缩短的独立危险因素。
中度 PPM 在接受主动脉瓣狭窄 AVR 的患者中较为常见，但重度不匹配罕见。PPM 患者的早期和晚期术后生存率相似。
