Cardiac Surgery, University Clinic Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Circulation. 2010 May 18;121(19):2123-9. doi: 10.1161/CIRCULATIONAHA.109.901272. Epub 2010 May 3.
Prosthesis-patient mismatch (P-PtM) after aortic valve replacement results in disturbed valve performance associated with increased pressure gradients. However, it is unknown whether this can be related to future structural valve deterioration (SVD) of the bioprosthesis.
In 564 patients (mean age, 74+/-5 years) receiving an aortic valve bioprosthesis, clinical follow-up (median, 6.1 years; maximum, 16.4 years) was analyzed including echocardiography. SVD was diagnosed in 40 patients (7%) as substantially increased stenosis (n=24) or regurgitation (n=16) of the operated valve over time. When patients with P-PtM (effective orifice area index <0.85 cm(2)/m(2); n=285) developed SVD, it was preferentially of the stenosis type, whereas when patients without P-PtM (n=279) developed SVD, the majority was of the incompetence type (P<0.05). Multivariable analysis including patient- and valve-related variables revealed that P-PtM and label size </=21 were independent predictors of SVD (P=0.04 and P=0.02, respectively). A nonparametric Turnbull estimate analysis showed that SVD is virtually nonexistent for up to 9 years in patients without P-PtM. Thereafter, SVD starts to occur and is mainly of the incompetence-type SVD (79% of cases). In patients with P-PtM, SVD starts to occur after 2 to 3 years after implantation and is mainly of the stenosis-type SVD (81% of cases).
These data suggest that stenosis-type SVD is an early, P-PtM-related, and thus preventable phenomenon. Incompetence-type SVD is a time-dependent, nonspecific wear damage to bioprosthetic valves, which is not related to P-PtM.
主动脉瓣置换术后人工瓣膜-患者不匹配（P-PtM）会导致瓣叶功能障碍，进而导致压力梯度增加。但是，目前尚不清楚这是否与生物瓣的未来结构性瓣膜退化（SVD）有关。
在 564 例（平均年龄 74+/-5 岁）接受主动脉瓣生物瓣置换术的患者中，分析了包括超声心动图在内的临床随访（中位数 6.1 年；最长 16.4 年）。随着时间的推移，40 例患者（7%）出现了手术瓣显著狭窄（n=24）或反流（n=16），被诊断为 SVD。当存在 P-PtM（有效瓣口面积指数<0.85 cm(2)/m(2)；n=285）的患者发生 SVD 时，主要为狭窄型，而当不存在 P-PtM（n=279）的患者发生 SVD 时，多数为关闭不全型（P<0.05）。包括患者和瓣膜相关变量的多变量分析显示，P-PtM 和标签尺寸≤21 是 SVD 的独立预测因子（P=0.04 和 P=0.02）。非参数特罗尔估计分析显示，在不存在 P-PtM 的患者中，SVD 在 9 年内实际上不存在。此后，SVD 开始发生，主要为关闭不全型 SVD（79%的病例）。在存在 P-PtM 的患者中，SVD 在植入后 2 至 3 年后开始发生，主要为狭窄型 SVD（81%的病例）。
这些数据表明，狭窄型 SVD 是一种早期、与 P-PtM 相关的、可预防的现象。关闭不全型 SVD 是生物瓣的一种时间依赖性、非特异性磨损损伤，与 P-PtM 无关。
