Hwang Ho Young, Kim Yong Han, Kim Kyung-Hwan, Kim Ki-Bong, Ahn Hyuk
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea.
Ann Thorac Surg. 2016 May;101(5):1796-802. doi: 10.1016/j.athoracsur.2015.10.032. Epub 2016 Jan 12.
We evaluated the impact of patient-prosthesis mismatch (PPM) after mitral valve replacement on the clinical outcomes using propensity score models.
In all, 760 patients (aged 51 ± 12 years; male:female = 252:508) in whom mitral valve replacement was performed using three types of mechanical valves and two types of bioprosthetic valves were enrolled. In vivo data of effective orifice area was drawn from literatures and mitral PPM was defined as an effective orifice area index 1.2 cm(2)/m(2) or less. The propensity score model was used in two ways: the inverse probability of treatment weighting-adjusted multivariable analyses, and 1:1 propensity score matching. The duration of the follow-up was 127 months (range, 1 to 276).
Mitral PPM was identified in 19.3%. The patients with PPM (PPM group, n = 147) were older and had more comorbidities than the patients without PPM (non-PPM group, n = 613). The 10-year and 20-year overall survival and freedom from cardiac death were 83.5% and 71.3%, respectively, for the PPM group; and 90.2% and 83.1%, respectively, for the non-PPM group. The inverse probability of treatment weighting-adjusted multivariable analyses demonstrated that mitral PPM is a significant risk factor for overall survival (hazard ratio 1.681, 95% confidence interval: 1.139 to 2.482) and freedom from cardiac death (hazard ratio 1.673, 95% confidence interval: 1.012 to 2.765). The propensity score matching extracted 68 pairs. Both overall survival and freedom from cardiac death were also higher in the propensity score-matched non-PPM group than in the PPM group (p = 0.039 and p = 0.017, respectively).
Mitral PPM significantly affects long-term outcomes after mitral valve replacement in terms of long-term survival and freedom from cardiac death.
我们使用倾向评分模型评估二尖瓣置换术后患者-假体不匹配（PPM）对临床结局的影响。
总共纳入了760例患者（年龄51±12岁；男性：女性=252：508），这些患者使用三种机械瓣膜和两种生物瓣膜进行了二尖瓣置换。有效瓣口面积的体内数据来自文献，二尖瓣PPM定义为有效瓣口面积指数小于1.2 cm²/m²。倾向评分模型有两种使用方式：治疗权重逆概率调整的多变量分析和1:1倾向评分匹配。随访时间为127个月（范围1至276个月）。
二尖瓣PPM的发生率为19.3%。与无PPM的患者（非PPM组，n=613）相比，PPM患者（PPM组，n=147）年龄更大，合并症更多。PPM组的10年和20年总生存率及无心脏死亡生存率分别为83.5%和71.3%；非PPM组分别为90.2%和83.1%。治疗权重逆概率调整的多变量分析表明，二尖瓣PPM是总生存（风险比1.681，95%置信区间：1.139至2.482）和无心脏死亡（风险比1.673，95%置信区间：1.012至2.765）的显著危险因素。倾向评分匹配提取了68对。倾向评分匹配的非PPM组的总生存率和无心脏死亡生存率也高于PPM组（分别为p=0.039和p=0.017）。
二尖瓣PPM在长期生存和无心脏死亡方面显著影响二尖瓣置换术后的长期结局。
