Northwestern University, Chicago, IL.
Circ Cardiovasc Imaging. 2013 Sep;6(5):776-83. doi: 10.1161/CIRCIMAGING.112.000319. Epub 2013 Aug 7.
The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines-suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area-indexed, effective orifice area (EOAi PPM) measurement.
A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤ 0.60 cm(2)/m(2), moderate if EOAi was 0.60 to 0.85 cm(2)/m(2), and absent (none) if EOAi was ≥ 0.85 cm(2)/m(2). ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM (P=1.00). ASE PPM differed significantly from EOAi PPM (P<0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1 ± 1.8 years; median, 3.9 years; range, 0.01-8 years). There were no reoperations for PPM.
In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.
人工瓣膜-患者不匹配（PPM）的流行程度及其对主动脉瓣置换术后生存的影响尚不清楚。历史上，PPM 是通过术后超声心动图或术前制造商提供的图表来确定的，这导致了很大的差异。2009 年美国超声心动图学会（ASE）指南提出了一种计算 PPM 的算法方法。本研究比较了 3 种方法的 PPM 流行程度及其对生存的影响：（1）ASE 指南建议的算法（ASE PPM）；（2）制造商提供的图表（MPPM）；（3）超声心动图测量的、体表面积指数化的有效瓣口面积（EOAi PPM）测量。
共有 614 例患者于 2004 年至 2009 年接受牛心包主动脉瓣置换术，且术前收缩功能正常。EOAi PPM 严重，如果 EOAI 小于或等于 0.60 cm2/m2；中度，如果 EOAI 为 0.60 至 0.85 cm2/m2；无（无），如果 EOAI 大于或等于 0.85 cm2/m2。ASE PPM 严重 22 例（3.6%），中度 6 例（1%），无（无）586 例（95.4%）。ASE PPM 与制造商提供的 PPM 相似（P=1.00）。ASE PPM 与 EOAi PPM 差异显著（P<0.001），其中 170 例（29.7%）严重不匹配，191 例（33.4%）中度不匹配，211 例（36.9%）无（无）。无论 PPM 分类方法如何，PPM 均未对中期生存率产生不利影响（平均随访 4.1±1.8 年；中位数 3.9 年；范围 0.01-8 年）。没有因 PPM 而进行再次手术。
在接受牛心包主动脉瓣置换术的收缩功能正常的患者中，使用算法-ASE 方法的 PPM 患病率较低，与制造商提供的 PPM 相关性良好。无论 PPM 评估方法如何，PPM 均与中期死亡率无关。
