反常低流量重度主动脉瓣狭窄患者中主动脉瓣假体-患者不匹配的流行率和长期结局。
Prevalence and long-term outcome of aortic prosthesis-patient mismatch in patients with paradoxical low-flow severe aortic stenosis.
机构信息
From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
出版信息
Circulation. 2014 Sep 9;130(11 Suppl 1):S25-31. doi: 10.1161/CIRCULATIONAHA.113.007819.
BACKGROUND
Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis-patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS.
METHODS AND RESULTS
Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm(2)). A PLF (indexed stroke volume ≤35 mL/m(2)) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area ≤0.85 cm(2)/m(2). The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P<0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P=0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5-4.45; P=0.0007).
CONCLUSIONS
In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome.
背景
与血流正常的患者相比，严重主动脉瓣狭窄（AS）合并反常低流量（PLF）的患者预后更差。此外，主动脉瓣置换术后的人工瓣膜-患者不匹配（PPM）是降低生存率的一个预测因素。然而，PLF-AS 患者 PPM 的患病率和预后影响尚不清楚。我们旨在分析 PLF-AS 患者 PPM 的患病率和长期生存率。
方法和结果
在 2000 年至 2010 年间，共纳入 677 例严重 AS、左心室射血分数正常且接受主动脉瓣置换术的患者（74±8 岁；42%为女性；主动脉瓣口面积为 0.69±0.16 cm2）。26%的患者存在 PLF（指数化的每搏量≤35 mL/m2），主动脉瓣置换术后，54%的患者存在 PPM，定义为指数化有效瓣口面积≤0.85 cm2/m2。同时存在 PLF 和 PPM 的患者占 15%。与无 PLF/无 PPM 的患者相比，PLF/PPM 的患者年龄更大，合并症更多。他们还经常接受更小的生物假体（所有 P<0.01）。尽管各组间早期死亡率无显著差异，但与无 PLF/无 PPM 组相比，PLF/PPM 组的 10 年生存率明显降低（38±9% vs. 70±5%；P=0.002），即使经过多变量调整后（危险比，2.58；95%置信区间，1.5-4.45；P=0.0007）。
结论
在这项大型基于导管的研究中，术前合并 PLF-AS 和术后合并 PPM 与最差的预后相关。
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