Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Eur Heart J. 2012 Jun;33(12):1518-29. doi: 10.1093/eurheartj/ehs003. Epub 2012 Mar 8.
Numerous studies have linked prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) to adverse outcomes. Its correlation with long-term survival has been described but with contradicting results. This systematic review and meta-analysis of observational studies aims to determine the hazard of PPM after AVR.
The Medline and EMBase databases were searched for English-language original publications. Two researchers independently screened studies and extracted data. Pooled estimates were obtained by random effects model. Subgroup analyses were performed to detect sources of heterogeneity. The search yielded 348 potentially relevant studies; 34 were included comprising 27 186 patients and 133 141 patient-years. Defined by the universally accredited indexed effective orifice area <0.85 cm(2)/m(2), 44.2% of patients were categorized as having PPM. In 34.2 and 9.8% of patients moderate (0.65-0.85 cm(2)/m(2)) and severe (<0.65 cm(2)/m(2)) PPM was present, respectively. Prosthesis-patient mismatch was associated with a statistically significant increase in all-cause mortality (HR = 1.34, 95% CI: 1.18-1.51), but only a trend to an increase in cardiac-related mortality (HR = 1.51, 95% CI: 0.88-2.60) was recognized. Analysis by severity of PPM demonstrated that both moderate and severe PPM increased all-cause mortality (HR = 1.19, 95% CI: 1.07-1.33 and HR = 1.84, 95% CI: 1.38-2.45) and cardiac-related mortality (HR = 1.32, 95% CI: 1.02-1.71 and HR = 6.46, 95% CI: 2.79-14.97). Further analyses showed a consistent effect over separate time intervals during follow-up.
Prosthesis-patient mismatch is associated with an increase in all-cause and cardiac-related mortality over long-term follow-up. We recommend that current efforts to prevent PPM should receive more emphasis and a widespread acceptance to improve long-term survival after AVR.
大量研究表明主动脉瓣置换（AVR）后人工瓣膜-患者不匹配（PPM）与不良结局相关。其与长期生存率的相关性已被描述，但结果存在矛盾。本系统评价和观察性研究的荟萃分析旨在确定 AVR 后 PPM 的危害。
检索了 Medline 和 EMBase 数据库中的英文原始出版物。两名研究人员独立筛选研究并提取数据。采用随机效应模型获得汇总估计值。进行亚组分析以发现异质性的来源。搜索产生了 348 篇潜在相关的研究；34 项研究被纳入，共包括 27186 名患者和 133141 患者年。根据普遍认可的有效开口面积指数<0.85cm2/m2，44.2%的患者被归类为 PPM。在 34.2%和 9.8%的患者中，分别存在中度（0.65-0.85cm2/m2）和重度（<0.65cm2/m2）PPM。PPM 与全因死亡率显著增加相关（HR=1.34，95%CI：1.18-1.51），但仅发现心脏相关死亡率有增加的趋势（HR=1.51，95%CI：0.88-2.60）。根据 PPM 的严重程度进行分析表明，中度和重度 PPM 均增加了全因死亡率（HR=1.19，95%CI：1.07-1.33 和 HR=1.84，95%CI：1.38-2.45）和心脏相关死亡率（HR=1.32，95%CI：1.02-1.71 和 HR=6.46，95%CI：2.79-14.97）。进一步的分析表明，在随访期间的不同时间间隔内均存在一致的效果。
PPM 与长期随访期间的全因死亡率和心脏相关死亡率增加相关。我们建议应更加重视当前预防 PPM 的努力，并广泛接受以改善 AVR 后的长期生存率。
