Deutsches Herzzentrum Berlin, Charité Campus Benjamin Franklin, Berlin, Germany.
J Thorac Cardiovasc Surg. 2013 Feb;145(2):391-7. doi: 10.1016/j.jtcvs.2012.01.043. Epub 2012 Feb 11.
Transcatheter aortic valve implantation (TAVI) has become an important therapeutic option for high-risk patients with severe aortic valve stenosis. Patient-prosthesis mismatch (P-PM) is an important determinant of morbidity and mortality after open aortic valve replacement. The objective of our study was to evaluate P-PM incidence and its impact on survival in a large cohort of patients treated with TAVI.
We retrospectively analyzed transesophageal echocardiographic data of 278 consecutive patients (Society of Thoracic Surgeons score 18.5 ± 15.3, age 80 ± 8 years) who underwent transapical TAVI with Edwards Sapien valves between April 2008 and March 2011. Effective orifice area was calculated using the continuity equation and indexed with body surface area (iEOA). P-PM was stratified as severe (iEOA < 0.65 cm(2)/cm(2)) and moderate (iEOA, 0.65-0.85 cm(2)/m(2)). Midterm survival (up to 30 months) was analyzed by Kaplan-Meier curves and log-rank tests. There was no P-PM in 181 (65.1%) patients; moderate P-PM was found in 76 (27.3%) patients and severe P-PM in 21 (7.6%). Thirty-day survival was 96.0%, 97.3%, and 90.5%. The 3-month survival was 91%, 90%, and 66%, respectively (P = .0013). Combination of severe P-PM with peak pressure gradients greater than 10 mm Hg further reduced the 3-month survival to 48%. Additionally, mean survival time in patients with an ejection fraction less than 50% was significantly shorter than in patients with an ejection fraction greater than 50% (20.8 ± 1.5 vs 24.1 ± 0.8 months; P = .027).
P-PM is found in patients undergoing transapical TAVI. Severe mismatch is accompanied by high early mortality, especially when combined with increased pressure gradients.
经导管主动脉瓣植入术（TAVI）已成为治疗高危重度主动脉瓣狭窄患者的重要治疗选择。患者-假体不匹配（P-PM）是开放式主动脉瓣置换术后发病率和死亡率的重要决定因素。我们的研究目的是评估在接受 TAVI 治疗的大样本患者中 P-PM 的发生率及其对生存率的影响。
我们回顾性分析了 2008 年 4 月至 2011 年 3 月期间接受经心尖 TAVI 并植入 Edwards Sapien 瓣膜的 278 例连续患者（胸外科医师学会评分 18.5±15.3，年龄 80±8 岁）的经食管超声心动图数据。有效瓣口面积采用连续方程计算，并以体表面积（iEOA）进行指数化。将 P-PM 分为严重（iEOA＜0.65cm²/cm²）和中度（iEOA，0.65-0.85cm²/m²）。通过 Kaplan-Meier 曲线和对数秩检验分析中期生存（最长 30 个月）。181 例（65.1%）患者无 P-PM；76 例（27.3%）患者为中度 P-PM，21 例（7.6%）患者为重度 P-PM。30 天生存率为 96.0%、97.3%和 90.5%。3 个月生存率分别为 91%、90%和 66%（P=0.0013）。严重 P-PM 与峰值压力梯度大于 10mmHg 相结合，进一步降低 3 个月生存率至 48%。此外，射血分数小于 50%的患者平均生存时间明显短于射血分数大于 50%的患者（20.8±1.5 与 24.1±0.8 个月；P=0.027）。
经心尖 TAVI 患者存在 P-PM。严重不匹配伴早期死亡率高，尤其是当与压力梯度增加相结合时。
