Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
PLoS One. 2013 Dec 3;8(12):e81940. doi: 10.1371/journal.pone.0081940. eCollection 2013.
"Patient-prosthesis mismatch" (PPM) after aortic valve replacement (AVR) has been reported to increase morbidity and mortality. Although algorithms have been developed to avoid PPM, factors favouring its occurrence have not been well defined.
This was a prospective cohort study performed at the Medical University of Vienna.
361 consecutive patients who underwent aortic valve replacement for isolated severe aortic stenosis were enrolled.
Patient- as well as prosthesis-related factors determining the occurrence of moderate and severe PPM (defined as effective orifice area indexed to body surface area ≤ 0.8 cm(2)/m(2)) were studied.
Postoperatively, 172 patients (48%) were diagnosed with PPM. The fact that predominantly female patients were affected (58% with PPM diagnosis in women versus 36% in men, p<0.001) was explained by the finding that they had smaller aortic root diameters (30.5±4.7 mm versus 35.3±4.2 mm, p<0.0001) and a higher proportion of bioprosthetic valves (82% versus 62%, p<0.0001), both independent predictors of PPM (aortic root diameter: OR 0.009 [95% CI, 0.004;0.013]; p = 0.0003, presence of bioprosthetic valve: OR 0.126 [95% CI, 0.078;0.175]; p<0.0001).
The occurrence of PPM is determined by aortic root diameter and prosthesis type. Novel sutureless bioprostheses with optimized hemodynamic performance or transcatheter aortic valves may become a promising alternative to conventional bioprosthetic valves in the future.
主动脉瓣置换术（AVR）后出现的“患者-假体不匹配”（PPM）已被报道会增加发病率和死亡率。尽管已经开发出算法来避免 PPM，但导致其发生的因素尚未得到很好的定义。
这是在维也纳医科大学进行的一项前瞻性队列研究。
361 例连续接受主动脉瓣置换术治疗孤立性严重主动脉瓣狭窄的患者入选。
研究了决定中度和重度 PPM（定义为有效瓣口面积与体表面积之比≤0.8 cm2/m2）发生的患者相关和假体相关因素。
术后，172 例（48%）患者被诊断为 PPM。主要为女性患者受影响（女性 PPM 诊断率为 58%，男性为 36%，p<0.001），这可以用主动脉根部直径较小（30.5±4.7 mm 与 35.3±4.2 mm，p<0.0001）和生物假体瓣膜比例较高（82%与 62%，p<0.0001）来解释，这两个因素都是 PPM 的独立预测因素（主动脉根部直径：OR 0.009[95%CI，0.004；0.013]；p=0.0003，生物假体瓣膜的存在：OR 0.126[95%CI，0.078；0.175]；p<0.0001）。
PPM 的发生取决于主动脉根部直径和假体类型。具有优化血流动力学性能的新型无缝线生物假体或经导管主动脉瓣可能成为未来替代传统生物假体瓣膜的有前途的选择。
