Swinkels Ben M, de Mol Bas A, Kelder Johannes C, Vermeulen Freddy E, ten Berg Jurriën M
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Ann Thorac Surg. 2016 Apr;101(4):1388-94. doi: 10.1016/j.athoracsur.2016.01.048. Epub 2016 Feb 26.
Mean follow-up in previous studies on the effect of prosthesis-patient mismatch on long-term survival after aortic valve replacement (AVR) is confined to a maximum of one decade. This retrospective longitudinal cohort study was performed to determine the effect on long-term survival of prosthesis-patient mismatch after AVR with a mean follow-up of almost two decades.
Kaplan-Meier survival analysis was used to determine long-term survival after AVR in a cohort of 673 consecutive patients, divided into 163 patients (24.2%) with prosthesis-patient mismatch (indexed effective orifice area ≤ 0.85 cm(2)/m(2)) and 510 patients (75.8%) without prosthesis-patient mismatch (indexed effective orifice area >0.85 cm(2)/m(2)). Effective orifice area values of the prosthetic valves were retrieved from the literature or obtained from the charts of the prosthetic valve manufacturers. Cox multiple regression analysis was used to identify possible independent predictors, including prosthesis-patient mismatch, of decreased long-term survival.
Median sizes of the implanted mechanical (n = 430) and biologic (n = 243) prostheses were 25 and 23 mm, respectively. Mean follow-up after AVR was 17.8 ± 1.8 years. Prosthesis-patient mismatch was not an independent predictor of decreased long-term survival (hazard ratio, 0.828; 95% confidence interval, 0.669 to 1.025; p = 0.083). Severe prosthesis-patient mismatch (indexed effective orifice area ≤ 0.65 cm(2)/m(2)), occurring in only 17 patients (2.5%), showed an insignificant trend toward decreased long-term survival (hazard ratio, 1.68; 95% confidence interval, 0.97 to 2.91; p = 0.066).
Prosthesis-patient mismatch was not an independent predictor of decreased long-term survival after AVR.
先前关于人工瓣膜-患者不匹配对主动脉瓣置换术（AVR）后长期生存影响的研究，平均随访时间最长为十年。本回顾性纵向队列研究旨在确定AVR后人工瓣膜-患者不匹配对长期生存的影响，平均随访时间近二十年。
采用Kaplan-Meier生存分析来确定673例连续患者AVR后的长期生存情况，这些患者被分为163例（24.2%）存在人工瓣膜-患者不匹配（指数化有效瓣口面积≤0.85 cm²/m²）和510例（75.8%）不存在人工瓣膜-患者不匹配（指数化有效瓣口面积>0.85 cm²/m²）的患者。人工瓣膜的有效瓣口面积值从文献中获取或从人工瓣膜制造商的图表中获得。采用Cox多元回归分析来确定可能的独立预测因素，包括人工瓣膜-患者不匹配，对长期生存降低的影响。
植入的机械瓣膜（n = 430）和生物瓣膜（n = 243）的中位尺寸分别为25和23 mm。AVR后的平均随访时间为17.8±1.8年。人工瓣膜-患者不匹配不是长期生存降低的独立预测因素（风险比，0.828；95%置信区间，0.669至1.025；p = 0.083）。严重的人工瓣膜-患者不匹配（指数化有效瓣口面积≤0.65 cm²/m²）仅发生在17例患者（2.5%）中，显示出长期生存降低的趋势不显著（风险比，1.68；95%置信区间，0.97至2.91；p = 0.066）。
人工瓣膜-患者不匹配不是AVR后长期生存降低的独立预测因素。
