二尖瓣位置的患者-假体不匹配会影响中期生存率和功能状态。
Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status.
机构信息
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Quebec, Canada.
出版信息
Can J Cardiol. 2010 Dec;26(10):532-6. doi: 10.1016/s0828-282x(10)70466-9.
BACKGROUND
The definition and incidence of patient-prosthesis mismatch (PPM) in the mitral position are unclear.
OBJECTIVES
To determine the impact of PPM on late survival and functional status after mitral valve replacement with a mechanical valve.
METHODS
Between 1992 and 2005, 714 patients (mean [± SD] age 60±10 years) underwent valve replacement with either St Jude (St Jude Medical Inc, USA) (n=295) or Carbomedics (Sulzer Carbomedics Inc, USA) (n=419) valves. There were 52 concomitant procedures (50 tricuspid annuloplasties, 25 foramen oval closures and 20 radiofrequency mazes). The mean clinical follow-up period was 4.4±3.3 years. The severity of PPM was established with cut-off values for an indexed effective orifice area (EOAi) of lower than 1.2 cm(2)⁄m(2), lower than 1.3 cm(2)⁄m(2) and lower than 1.4 cm(2)⁄m(2). Parametric and nonparametric tests were used to determine predictors of outcome.
RESULTS
The prevalence of PPM was 3.7%, 10.1% and 23.5% when considering values of lower than 1.2 cm(2)⁄m(2), lower than 1.3 cm(2)⁄m(2) and lower than 1.4 cm(2)⁄m(2), respectively. When considering functional improvement, patients with an EOAi of 1.4 cm(2)⁄m(2) or greater had a better outcome than those with an EOAi of lower than 1.4 cm(2)⁄m(2) (OR 1.98; P=0.03). When building a Cox-proportional hazard model, PPM with an EOAi of less than 1.3 cm(2)⁄m(2) was an independent predictive factor for midterm survival (HR 2.24, P=0.007). Other factors affecting survival were age (HR 1.039), preoperative New York Heart Association class (HR 1.96) and body surface area (HR 0.31).
CONCLUSIONS
In a large cohort of patients undergoing mitral valve replacement with mechanical prostheses, PPM defined as an EOAi of lower than 1.3 cm(2)⁄m(2) significantly decreased midterm survival. This level of PPM was observed in 10.2% of patients. Patients with an EOAi of 1.4 cm(2)⁄m(2) or greater had greater improvement of their functional status.
背景
二尖瓣位置的患者-假体不匹配（PPM）的定义和发生率尚不清楚。
目的
确定二尖瓣置换术后机械瓣 PPM 对晚期生存和功能状态的影响。
方法
1992 年至 2005 年间，714 例患者（平均年龄 60±10 岁）接受了 St Jude（美国 St Jude Medical Inc）（n=295）或 Carbomedics（美国 Sulzer Carbomedics Inc）（n=419）瓣膜置换术。有 52 例合并手术（50 例三尖瓣环成形术、25 例卵圆孔闭合术和 20 例射频迷宫术）。平均临床随访时间为 4.4±3.3 年。通过截距值确定 PPM 的严重程度，有效瓣口面积（EOAi）指数低于 1.2 cm(2)⁄m(2)、低于 1.3 cm(2)⁄m(2)和低于 1.4 cm(2)⁄m(2)。使用参数和非参数检验来确定结果的预测因素。
结果
考虑到低于 1.2 cm(2)⁄m(2)、低于 1.3 cm(2)⁄m(2)和低于 1.4 cm(2)⁄m(2)的值时，PPM 的患病率分别为 3.7%、10.1%和 23.5%。考虑到功能改善，EOAi 为 1.4 cm(2)⁄m(2)或更高的患者比 EOAI 低于 1.4 cm(2)⁄m(2)的患者有更好的结果（OR 1.98；P=0.03）。在构建 Cox 比例风险模型时，有效瓣口面积指数（EOAi）低于 1.3 cm(2)⁄m(2)的 PPM 是中期生存的独立预测因素（HR 2.24，P=0.007）。影响生存的其他因素是年龄（HR 1.039）、术前纽约心脏协会（NYHA）分级（HR 1.96）和体表面积（HR 0.31）。
结论
在接受机械瓣膜二尖瓣置换术的大量患者队列中，有效瓣口面积指数（EOAi）低于 1.3 cm(2)⁄m(2)的 PPM 显著降低了中期生存率。在 10.2%的患者中观察到这种程度的 PPM。EOAi 为 1.4 cm(2)⁄m(2)或更高的患者功能状态改善更大。
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