Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2010 Jul 15;106(2):255-60. doi: 10.1016/j.amjcard.2010.02.036.
A prosthesis-patient mismatch (PPM) is present when the prosthetic valve is too small in relation to the patient's body size. The purpose of the present study was to investigate the frequency of PPM after the implantation of the Medtronic CoreValve System, and its relation to the clinical outcome. The indexed effective orifice area (EOA) was measured in 74 patients with symptomatic severe aortic stenosis, who had undergone successful transcatheter aortic valve implantation with the Medtronic CoreValve System, at baseline and discharge. PPM was defined as severe (indexed EOA <0.65 cm(2)/m(2)) or moderate (indexed EOA 0.65 to 0.85 cm(2)/m(2)). The indexed EOA increased from 0.35 +/- 0.13 to 0.97 +/- 0.34 cm(2)/m(2) after transcatheter aortic valve implantation (p <0.001) and was accompanied by significant clinical improvement. Severe and moderate PPMs were found in 16% and 23% of patients, respectively. Patients with severe PPM were more symptomatic and had a smaller indexed EOA at baseline than those with moderate or no PPM (0.28 +/- 0.09 vs 0.36 +/- 0.12 cm(2)/m(2), p <0.05). Functional status and mortality at 30 days and 6 months was not significantly different between the patients with severe PPM and those with moderate or no PPM. In conclusion, the indexed EOA increased significantly after transcatheter aortic valve implantation. Severe PPM was observed in 16% of the patients and was not associated with the clinical outcome.
人工心脏瓣膜-患者不匹配（PPM）是指人工瓣膜相对于患者的体型过小。本研究的目的是调查经导管主动脉瓣植入术后 PPM 的发生频率及其与临床结果的关系。对 74 例有症状的重度主动脉瓣狭窄患者，在基线和出院时用经导管主动脉瓣植入术的美敦力 CoreValve 系统测量有效开口面积指数（EOA）。PPM 定义为重度（指数 EOA <0.65 cm²/m²）或中度（指数 EOA 0.65-0.85 cm²/m²）。经导管主动脉瓣植入术后，指数 EOA 从 0.35±0.13cm²/m²增加至 0.97±0.34cm²/m²（p<0.001），同时伴有显著的临床改善。分别有 16%和 23%的患者发现重度和中度 PPM。与中度或无 PPM 患者相比，重度 PPM 患者的症状更明显，且基线时的指数 EOA 更小（0.28±0.09 vs 0.36±0.12 cm²/m²，p<0.05）。重度 PPM 患者与中度或无 PPM 患者在 30 天和 6 个月时的功能状态和死亡率无显著差异。结论：经导管主动脉瓣植入术后指数 EOA 显著增加。16%的患者存在重度 PPM，但其与临床结果无关。
