Urso Stefano, Calderón Pilar, Sadaba Rafael, Mahillo Ignacio, Tuñón José, Aldamiz Gonzalo, Fraile Julián
Department of Cardiac Surgery, Hospital Dr.Negrín, Las Palmas de Gran Canaria, Spain.
J Card Surg. 2014 Jul;29(4):439-44. doi: 10.1111/jocs.12345. Epub 2014 Apr 29.
Patient-prosthesis mismatch has been identified as a risk factor for mortality after aortic valve replacement and for structural valve deterioration (SVD) in patients receiving a bioprosthetic aortic valve. The aim of the present study was to compare the incidence of aortic valve bioprosthesis replacement for SVD in patients with mismatch to a population without mismatch.
Three hundred eighty-seven adult patients who underwent aortic valve replacement with a bioprosthesis from 1974 to 2009 were retrospectively reviewed. Mismatch was considered to be present if the anticipated indexed effective orifice area was <0.70 cm(2) /m(2) . The median follow-up period was 7.2 years. Follow-up was 97% complete.
Patient-prosthesis mismatch was present in 12% of the study population (n = 47). Ten-year freedom from reoperation for aortic bioprosthesis replacement was 74.3 ± 3.2%. During follow-up, 111 patients underwent reoperation for aortic bioprosthesis replacement. Causes of aortic bioprosthesis replacement were SVD of the bioprosthesis (n = 96), paravalvular leak (n = 10), and acute endocarditis (n = 5). According to unadjusted Kaplan-Meier analysis, patients with mismatch had a higher incidence of aortic bioprosthesis replacement for SVD when compared with patients without mismatch (log rank test: p 0.05). This result was confirmed by multivariable Cox regression analysis, which identified two independent predictors of aortic bioprosthesis replacement for SVD: patients' age (hazard ratio (HR) 0.967) and patient-prosthesis mismatch (HR 2.161).
Patients suffering from mismatch were twice as likely to undergo reoperation for aortic bioprosthesis replacement for SVD than those without mismatch.
患者-人工瓣膜不匹配已被确定为主动脉瓣置换术后死亡以及接受生物人工主动脉瓣患者发生人工瓣膜结构退化（SVD）的危险因素。本研究的目的是比较存在不匹配的患者与不存在不匹配的人群中因SVD进行主动脉瓣生物人工瓣膜置换的发生率。
回顾性分析了1974年至2009年期间接受生物人工瓣膜主动脉瓣置换的387例成年患者。如果预期的体表面积校正有效瓣口面积<0.70 cm²/m²，则认为存在不匹配。中位随访期为7.2年。随访完成率为97%。
研究人群中12%（n = 47）存在患者-人工瓣膜不匹配。生物人工主动脉瓣置换术后10年免于再次手术的比例为74.3 ± 3.2%。随访期间，111例患者因生物人工主动脉瓣置换接受了再次手术。生物人工主动脉瓣置换的原因包括生物人工瓣膜的SVD（n = 96）、瓣周漏（n = 10）和急性心内膜炎（n = 5）。根据未校正的Kaplan-Meier分析，与不存在不匹配的患者相比，存在不匹配的患者因SVD进行生物人工主动脉瓣置换的发生率更高（对数秩检验：p < 0.05）。多变量Cox回归分析证实了这一结果，该分析确定了生物人工主动脉瓣置换治疗SVD的两个独立预测因素：患者年龄（风险比[HR] 0.967）和患者-人工瓣膜不匹配（HR 2.161）。
存在不匹配的患者因SVD进行生物人工主动脉瓣置换再次手术的可能性是不存在不匹配患者的两倍。
