Department of Cardiology and Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
J Am Coll Cardiol. 2011 Oct 25;58(18):1910-8. doi: 10.1016/j.jacc.2011.08.027. Epub 2011 Oct 6.
This study examined the mid-term hemodynamic and clinical impact of prosthesis-patient mismatch (PPM) in patients undergoing transcatheter aortic valve implantation (TAVI) with balloon-expandable valves.
PPM can be observed after aortic valve surgery. However, little is known about the incidence of PPM in patients undergoing TAVI.
Echocardiography and clinical assessment were performed in 165 patients at baseline, before hospital discharge, and at 6 months after TAVI. PPM was defined as an indexed effective orifice area ≤0.85 cm(2)/m(2).
Thirty patients (18.2%) showed PPM before hospital discharge. At baseline, patients with PPM had a larger body surface area (1.84 ± 0.18 m(2) vs. 1.73 ± 0.18 m(2), p = 0.003) and a greater severity of aortic stenosis (indexed valve area 0.35 ± 0.09 cm(2)/m(2) vs. 0.40 ± 0.10 cm(2)/m(2), p = 0.005) than patients without PPM. Patients with PPM demonstrated a slower and smaller reduction in mean transaortic gradient, limited left ventricular (LV) mass regression, and left atrial volume reduction over 6 months compared with patients without PPM. LV filling pressure, measured by E/e', tended to remain elevated in patients with PPM. Importantly, a higher proportion of patients with PPM did not improve in New York Heart Association functional class compared with patients without PPM (36.7% vs. 1.5%, p < 0.001), although major adverse valve-related and cardiovascular events did not differ between the 2 groups.
PPM may be observed after TAVI and when present may be accompanied by less favorable changes in transvalvular hemodynamics, limited LV mass regression, persistent elevated LV filling pressure, and less improvement in clinical functional status.
本研究旨在探讨经导管主动脉瓣植入术（TAVI）中使用球囊扩张瓣时，假体-患者不匹配（PPM）对中期血流动力学和临床的影响。
在主动脉瓣手术后可观察到 PPM。然而，对于 TAVI 患者中 PPM 的发生率知之甚少。
对 165 例患者进行基线、出院前和 TAVI 后 6 个月的超声心动图和临床评估。将 PPM 定义为有效瓣口面积指数（IEA）≤0.85cm²/m²。
出院前有 30 例（18.2%）患者出现 PPM。基线时，PPM 患者的体表面积较大（1.84±0.18m²与 1.73±0.18m²，p=0.003），主动脉瓣狭窄程度更严重（IEA 0.35±0.09cm²/m²与 0.40±0.10cm²/m²，p=0.005）。与无 PPM 的患者相比，PPM 患者的平均跨瓣梯度降低更慢、幅度更小，左心室（LV）质量回归有限，左心房容积减小。在 6 个月时，LV 充盈压，通过 E/e'测量，在 PPM 患者中仍有升高趋势。重要的是，与无 PPM 的患者相比，PPM 患者的纽约心脏协会（NYHA）心功能分级改善的比例较低（36.7%与 1.5%，p<0.001），尽管两组之间主要不良瓣膜相关和心血管事件无差异。
TAVI 后可出现 PPM，存在 PPM 时，跨瓣血流动力学变化可能更差，LV 质量回归有限，LV 充盈压持续升高，临床心功能状态改善不明显。
