Dayan Victor, Soca Gerardo, Stanham Roberto, Lorenzo Alvaro, Ferreiro Alejandro
Instituo Nacional de Cirugia Cardiaca, Montevideo Uruguay.
Instituo Nacional de Cirugia Cardiaca, Montevideo Uruguay.
Int J Cardiol. 2015;190:389-92. doi: 10.1016/j.ijcard.2015.04.161. Epub 2015 Apr 21.
Patient-prosthesis mismatch (PPM) has ignited much debate and no definite conclusions have been drawn on the outcome of these patients. Therefore, additional large studies with long-term follow-up are required to help the cardiologist and surgeon outline the best therapeutic strategy for patients with high risk for PPM.
Patients who underwent aortic valve replacement (AVR) from 2000 to 2013 were identified. Baseline and operative data was extracted and indexed effective orifice area calculated for each patient. The presence of PPM was defined in those patients with an iEOA ≤ 0.85 cm(2)/m(2). Regression analyses were performed to determine the association of PPM with operative mortality, post-operative complications and survival. Predictors for PPM were evaluated based on clinical and operative data.
From 2023 patients who underwent AVR, PPM was present in 64.6%. These patients had increased age, more coronary artery bypass procedures, increased risk of diabetes, hypertension, higher creatinine values and higher Euroscore. Age, body surface area, prosthesis type and size were found to be predictors of mismatch. Operative mortality (8.1% vs 5.7%, p = 0.05), stroke (3.9% vs 2.4, p = 0.02) and acute kidney injury (47.6% vs 35.1%, p =< 0 .001) were more frequent in patients with PPM and mean 10-year survival was reduced (6.6 years, 95% CI: 6.3-6.8 vs 7.3, 95% CI: 6.9-7.2, p < 0.001). After adjusting for confounders, PPM was not found to be associated to either adverse outcome or survival.
Patients with PPM have worse operative mortality, post-operative complications and survival mainly due to the fact that they represent a higher risk population based on age and co-morbidities.
人工瓣膜-患者不匹配（PPM）引发了诸多争论，对于这些患者的预后尚未得出明确结论。因此，需要开展更多长期随访的大型研究，以帮助心脏病专家和外科医生为PPM高危患者制定最佳治疗策略。
确定2000年至2013年期间接受主动脉瓣置换术（AVR）的患者。提取基线和手术数据，并计算每位患者的指数有效瓣口面积。iEOA≤0.85 cm²/m²的患者被定义为存在PPM。进行回归分析以确定PPM与手术死亡率、术后并发症和生存率之间的关联。基于临床和手术数据评估PPM的预测因素。
在2023例接受AVR的患者中，64.6%存在PPM。这些患者年龄更大，接受冠状动脉搭桥手术的次数更多，患糖尿病、高血压的风险增加，肌酐值更高，欧洲心脏手术风险评估系统（Euroscore）评分更高。年龄、体表面积、人工瓣膜类型和尺寸被发现是不匹配的预测因素。PPM患者的手术死亡率（8.1%对5.7%，p = 0.05）、中风（3.9%对2.4%，p = 0.02）和急性肾损伤（47.6%对35.1%，p≤0.001）更为常见，平均10年生存率降低（6.6年，95%置信区间：6.3 - 6.8对7.3年，95%置信区间：6.9 - 7.2，p < 0.001）。在对混杂因素进行调整后，未发现PPM与不良结局或生存率相关。
PPM患者的手术死亡率、术后并发症和生存率更差，主要是因为基于年龄和合并症，他们代表了更高风险的人群。
