Matsuura Kaoru, Mogi Kenji, Aoki Chikashi, Takahara Yoshiharu
Department of Cardiovascular Surgery, Funabashi Municipal Medical Center, Funabashi, Chiba, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(2):153-9. doi: 10.5761/atcs.oa.10.01558.
The aim of this study was to determine the impact of patient-prosthesis mismatch (PPM) after mitral valve replacement (MVR) on the late clinical outcome, evaluated from the referred value and measured mitral valve area in the echocardiograph.
The records of 212 patients who underwent MVR between 1995 and 2008 at Funabashi Municipal Medical Center, Japan were studied retrospectively. Exclusions were patients who had a repeat MVR or concomitant aortic valve surgery. Of 212 patients, 163 underwent the Doppler echocardiographic study more than 1 year after surgery. Primary endpoint was late survival, and secondary endpoint was major adverse cardiac event (MACE). The average follow-up period was 53.1 ± 100.8 months. The effective orifice area index (EOAI) was calculated using the referred effective orifice area (r-EOA) and measured effective orifice area (m-EOA). An EOAI smaller than 1.2 cm2/m2 defined PPM.
For r-EOAI, 125 patients (group P) had PPM and 87 patients (group N) did not. Between groups, there was a significant difference in the proportion of males (group P vs. N; 59% vs. 23%; P = 0.0001), postoperative NYHA class (1.02 ± 6.2 vs. 9.8 ± 1.6, P = 0.04), late mitral valve area (MVA) (2.50 ± 0.56 vs. 2.78 ± 0.60, P = 0.005), and peak transmitral pressure gradient (MPG) 11.9 ± 6.2 vs 9.8 ± 1.6, P = 0.04). However, there was no difference in late survival (P = 0.55) or incidence of a major cardiac adverse event (MACE) (P = 0.14). For m-EOAI, 17 patients (group P) had PPM and 146 patients (group N) did not. Between groups, there was a difference in the bioprosthetic valve (group P vs. N; 76% vs. 26%, P = 0.006) and mean MPG (5.2 ± 2.3 vs. 3.7 ± 1.8, P = 0.02). However, there was no difference in late survival (P = 0.99) and incidence of MACE (P = 0.86). The r- and m-EOAI were well correlated (correlation coefficient 0.46; 0.33-0.5)
The PPM after MVR was not related to the late survival or the incidence of MACE based on both r- and m-EOAI. The patient group of PPM defined by r-EOAI tended to be male and that defined by m-EOAI tended to be bioprosthetic.
本研究旨在通过超声心动图中参考值和测量的二尖瓣面积，确定二尖瓣置换术（MVR）后患者-假体不匹配（PPM）对晚期临床结局的影响。
回顾性研究了1995年至2008年期间在日本船桥市立医疗中心接受MVR的212例患者的记录。排除进行过再次MVR或同期主动脉瓣手术的患者。212例患者中，163例在术后1年以上接受了多普勒超声心动图检查。主要终点是晚期生存率，次要终点是主要不良心脏事件（MACE）。平均随访期为53.1±100.8个月。使用参考有效瓣口面积（r-EOA）和测量的有效瓣口面积（m-EOA）计算有效瓣口面积指数（EOAI）。EOAI小于1.2 cm2/m2定义为PPM。
对于r-EOAI，125例患者（P组）存在PPM，87例患者（N组）不存在PPM。两组之间，男性比例（P组 vs. N组；59% vs. 23%；P = 0.0001）、术后纽约心脏协会（NYHA）分级（1.02±6.2 vs. 9.8±1.6，P = 0.04）、晚期二尖瓣面积（MVA）（2.50±0.56 vs. 2.78±0.60，P = 0.005）和二尖瓣峰值跨瓣压差（MPG）（11.9±6.2 vs 9.8±1.6，P = 0.04）存在显著差异。然而，晚期生存率（P = 0.55）或主要心脏不良事件（MACE）发生率（P = 0.14）无差异。对于m-EOAI，17例患者（P组）存在PPM，146例患者（N组）不存在PPM。两组之间，生物瓣（P组 vs. N组；76% vs. 26%，P = 0.006）和平均MPG（5.2±2.3 vs. 3.7±1.8，P = 0.02）存在差异。然而，晚期生存率（P = 0.99）和MACE发生率（P = 0.86）无差异。r-EOAI和m-EOAI相关性良好（相关系数0.46；0.33 - 0.5）
基于r-EOAI和m-EOAI，MVR后的PPM与晚期生存率或MACE发生率无关。由r-EOAI定义的PPM患者组倾向于男性，由m-EOAI定义的PPM患者组倾向于使用生物瓣。
