Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Thorac Cardiovasc Surg. 2011 Aug;142(2):e5-9. doi: 10.1016/j.jtcvs.2010.08.043. Epub 2010 Nov 11.
We examined the role of prosthesis-patient mismatch on left ventricular mass regression after aortic valve replacement for chronic aortic valve regurgitation.
We selected patients who had complete preoperative and follow-up echocardiograms with measurement of left ventricular mass. Patients were excluded who had moderate or greater aortic valve stenosis, concomitant coronary artery bypass grafting, or mitral valve procedures.
Patients' mean age was 55 ± 17 years; 21% were female. The mean preoperative indexed left ventricular mass was 150 ± 45 g/m(2). Patients with mildly (n = 44; mean indexed mass, 126 ± 15 g/m(2)), moderately (n = 31; mean indexed mass, 168 ± 11 g/m(2)), or severely (n = 15; mean indexed mass, 241 ± 34 g/m(2)) increased preoperative indexed left ventricular mass, were similar, except for lower ejection fractions, larger end-diastolic dimensions, and larger ventricular wall thicknesses in the severely enlarged group (P < .001). Thirteen patients had prosthesis-patient mismatch and were similar to patients without prosthesis-patient mismatch, except for a greater body surface area, fewer mechanical valves, and smaller valve sizes in those with prosthesis-patient mismatch (P < .05). At a mean follow-up of 3.2 ± 2.4 years, the average reduction in indexed left ventricular mass was 50 ± 38 g/m(2); late mass regression was unrelated to labeled valve size, prosthesis-patient mismatch, or measured indexed effective aortic valve area. A greater preoperative indexed left ventricular mass (P < .001) was an independent predictor of greater left ventricular mass regression. Despite having greater left ventricular mass regression, patients with severe preoperative indexed left ventricular mass did not return to normal values (mean, 142 ± 25 g/m(2)).
Left ventricular mass regression after aortic valve replacement for chronic aortic regurgitation is unrelated to indexed prosthetic valve area. Although incomplete, regression is greatest in patients with the largest preoperative indexed left ventricular mass.
我们研究了人工瓣膜-患者不匹配对慢性主动脉瓣反流主动脉瓣置换术后左心室质量回归的影响。
我们选择了具有完整术前和随访超声心动图并测量左心室质量的患者。排除中度或重度主动脉瓣狭窄、同时行冠状动脉旁路移植术或二尖瓣手术的患者。
患者的平均年龄为 55±17 岁，21%为女性。术前左心室质量指数平均值为 150±45g/m2。轻度（n=44；平均指数质量 126±15g/m2）、中度（n=31；平均指数质量 168±11g/m2）和重度（n=15；平均指数质量 241±34g/m2）左心室质量指数增加的患者之间无差异，除了重度左心室质量指数增加的患者射血分数较低、舒张末期内径较大和心室壁厚度较大（P<0.001）。13 例患者存在人工瓣膜-患者不匹配，与无人工瓣膜-患者不匹配的患者相似，除了人工瓣膜-患者不匹配的患者体表面积较大、机械瓣较少和瓣膜尺寸较小（P<0.05）。在平均 3.2±2.4 年的随访中，左心室质量指数的平均降低值为 50±38g/m2；晚期质量回归与标记的瓣膜尺寸、人工瓣膜-患者不匹配或测量的有效主动脉瓣口面积无关。术前左心室质量指数较大（P<0.001）是左心室质量回归较大的独立预测因子。尽管左心室质量回归较大，但术前左心室质量指数重度增加的患者未恢复正常（平均为 142±25g/m2）。
慢性主动脉瓣反流主动脉瓣置换术后左心室质量回归与人工瓣膜指数面积无关。尽管不完全，但回归在术前左心室质量指数最大的患者中最大。
