Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Heart. 2014 Jul;100(14):1099-106. doi: 10.1136/heartjnl-2013-305118. Epub 2014 May 19.
Age may modify the impact of prosthesis-patient mismatch (PPM) on outcomes after aortic valve replacement (AVR), as physical functioning decreases with age, and comorbidities become more prevalent. We hypothesised that the consequences of PPM in patients 70 years old or older may be less important than in younger patients.
In total, 707 aortic stenosis patients were followed for a maximum of 17.5 years after AVR. PPM was defined as an in vivo indexed effective orifice area ≤0.85 cm2/m2, and severe PPM as ≤0.65 cm2/m2.
In patients less than 70 years of age with normal LV function, the presence of PPM did not significantly alter survival. However, in patients under 70 with LV dysfunction, PPM was associated with decreased survival (HR 2.2; p=0.046). In patients aged 70 years of age or older, PPM had no effect on survival, regardless of LV function. Similarly, PPM was predictive of postoperative congestive heart failure (CHF) in patients under 70 with LV dysfunction (HR 3.6; p=0.046) but not in older patients. Similar results were observed for the composite endpoint of death or CHF. Postoperative LV mass regression was impaired by increased age (p=0.019), and by PPM in patients aged 70 years of age or older with LV dysfunction (by 28.8 g/m2; p=0.026).
The impact of PPM on outcomes after AVR depends on age at operation. PPM in patients under age 70 years with LV dysfunction is associated with decreased survival and lower freedom from CHF. In patients 70 years of age or older, PPM does not impact mortality or symptoms, but impairs LV mass regression beyond that explained by age alone.
年龄可能会改变假体-患者不匹配（PPM）对主动脉瓣置换（AVR）后结果的影响，因为随着年龄的增长，身体机能会下降，合并症也会更加普遍。我们假设，70 岁或以上患者的 PPM 后果可能不如年轻患者重要。
共有 707 例主动脉瓣狭窄患者在 AVR 后最长 17.5 年的时间内接受了随访。PPM 定义为体内索引有效瓣口面积≤0.85cm2/m2，严重 PPM 定义为≤0.65cm2/m2。
在左心室功能正常的年龄小于 70 岁的患者中，PPM 的存在并未显著改变生存率。然而，在左心室功能障碍的年龄小于 70 岁的患者中，PPM 与生存率降低相关（HR 2.2；p=0.046）。在 70 岁及以上的患者中，无论左心室功能如何，PPM 对生存率均无影响。同样，PPM 可预测左心室功能障碍的年龄小于 70 岁的患者术后充血性心力衰竭（CHF）（HR 3.6；p=0.046），但对年龄较大的患者则无影响。对于死亡或 CHF 的复合终点也观察到了类似的结果。LV 质量的术后回归因年龄增加而受损（p=0.019），在左心室功能障碍的 70 岁及以上的患者中，PPM 使 LV 质量回归进一步受损（28.8g/m2；p=0.026）。
PPM 对 AVR 后结果的影响取决于手术时的年龄。左心室功能障碍的年龄小于 70 岁的患者中，PPM 与生存率降低和 CHF 发生率降低相关。在 70 岁及以上的患者中，PPM 不会影响死亡率或症状，但会使 LV 质量的回归受损，超出单纯年龄的影响。
