Hernandez-Vaquero Daniel, Garcia Jose M, Diaz Rocio, Calvo David, Khalpey Zain, Hernández Ernesto, Rodriguez Víctor, Morís César, Llosa Juan C
Department of Cardiac Surgery, Central Universitary Hospital of Asturias, Oviedo, Spain.
J Card Surg. 2014 Mar;29(2):127-33. doi: 10.1111/jocs.12265. Epub 2013 Dec 12.
The clinical impact of patient-prosthesis mismatch (PPM) on outcomes in young and middle-aged patients undergoing surgery for aortic valve replacement (AVR) remains unknown. Our objective was to examine the mid-term impact of PPM on overall mortality, quality of life, and cardiac events in this population.
All patients younger than 70 years of age undergoing isolated AVR from October 2005 to October 2011 were analyzed. PPM was defined as the indexed effective orifice area ≤ 0.85 cm(2) /m(2) . We studied the impact of PPM on mid-term overall mortality, cardiac events, and New York Heart Association functional class using an analysis stratified for propensity score. Cardiac events were defined as cardiac death, sudden death, hospital readmission due to angina, syncope or heart failure or reoperation on aortic prosthesis.
Two hundred and ninety-three patients were included in the study, of whom 81 (27.61%) had some degree of PPM. PPM had no impact on mid-term overall mortality (HR=1.45; 95% CI=0.65-3.22; p=0.36), although it had a negative impact on cardiac events (HR=11.52; 95% CI=5.25-25.24; p<0.001) and functional class (RR=7.55; 95% CI=2.59-22.03; p<0.001).
Moderate PPM appears to be a strong and independent predictor of cardiac events and advanced functional class in young and middle-aged patients undergoing AVR for severe stenosis. However, it is possible that it has no impact on overall mortality.
患者-人工瓣膜不匹配（PPM）对中青年患者主动脉瓣置换术（AVR）手术结局的临床影响尚不清楚。我们的目的是研究PPM对该人群中期全因死亡率、生活质量和心脏事件的影响。
分析2005年10月至2011年10月期间所有年龄小于70岁接受单纯AVR的患者。PPM定义为指数化有效瓣口面积≤0.85 cm²/m²。我们使用倾向评分分层分析研究PPM对中期全因死亡率、心脏事件和纽约心脏协会心功能分级的影响。心脏事件定义为心源性死亡、猝死、因心绞痛、晕厥或心力衰竭住院再入院或主动脉人工瓣膜再次手术。
293例患者纳入研究，其中81例（27.61%）有一定程度的PPM。PPM对中期全因死亡率无影响（HR=1.45；95%CI=0.65-3.22；p=0.36），尽管它对心脏事件有负面影响（HR=11.52；95%CI=5.25-25.24；p<0.001）和心功能分级（RR=7.55；95%CI=2.59-22.03；p<0.001）。
对于因严重狭窄接受AVR的中青年患者，中度PPM似乎是心脏事件和高级心功能分级的有力且独立的预测因素。然而，它可能对全因死亡率无影响。
