二尖瓣置换术后人工瓣膜-患者不匹配的影响

Impact of Prosthesis-Patient Mismatch after Mitral Valve Replacement.

作者信息

Pisano Calogera, Rita Balistreri Carmela, Fabio Triolo Oreste, Franchino Rosalba, Allegra Alberto, Capuccio Veronica, Argano Vincenzo, Ruvolo Giovanni

机构信息

Unit of Cardiac Surgery, Department of Surgery and Oncology.

Department of Pathobiology and Medical and Biotechnologies.

出版信息

J Heart Valve Dis. 2016 Jan;25(1):39-45.

PMID:27989082

Abstract

BACKGROUND

The study aim was to determine the impact of prosthesis-patient mismatch (PPM) on early and late clinical outcomes, left atrial and ventricular remodeling, late tricuspid valve regurgitation and pulmonary hypertension (PH) in patients after mitral valve replacement (MVR).

METHODS

A total of 46 patients (mean age 66 ± 9.3 years) with mitral valve diseases and undergoing isolated MVR was enrolled in the study. The mitral valve effective orifice area (EOA) was determined using the continuity equation and indexed for the patient's body surface area (EOAi). PPM was defined as EOAi ≤1.2 cm2/m2. PH was defined as a systolic pulmonary artery pressure (sPAP) >40 mmHg. Both, clinical and echocardiographic follow up were performed.

RESULTS

PPM was identified in 25% of patients, but no significant differences were observed in baseline and operative characteristics when comparing patients with and without PPM. The NYHA class was improved in most cases after surgery. Indeed, significant decreases in mean transvalvular gradient (from 8.6 ± 2.8 mmHg to 5 ± 1.3 mmHg, p = 0.001), left atrial dimension (LAD) (from 31.9 ±9.8 mm to 29.5 ± 7 mm, p = 0.011), left ventricular end-systolic diameter (from 42.6 ± 18.1 mm to 35.5 ± 6.6 mm, p = 0.044) and left ventricular end-diastolic diameter (from 55.8 ± 19.2 mm to 48.7 ± 6.1 mm, p = 0.024) were observed over time when comparing preoperative and postoperative echocardiographic data. In addition, at follow up (mean 6.9 ± 1.8 years) there were significant decreases in LAD (from 31.9 ± 9.8 mm to 28 ± 11.1 mm, p = 0.001), left ventricular enddiastolic volume (from 106.9 ± 32.9 ml to 92.3 ± 21.9 ml, p = 0.024), tricuspid regurgitation (TR) (from 87% to 27%, p = 0.002) and PH (from 78.3% to 58.7%, p = 0.043) in all patients. No significant differences were observed in hemodynamic, clinical outcome and atrial natriuretic peptide levels of patients with and without PPM.

CONCLUSIONS

Mitral PPM does not appear to have any negative effect on ventricular and atrial remodeling, TR and PH during the early and late postoperative periods.

摘要

背景

本研究旨在确定人工瓣膜-患者不匹配（PPM）对二尖瓣置换术（MVR）后患者的早期和晚期临床结局、左心房和心室重构、晚期三尖瓣反流及肺动脉高压（PH）的影响。

方法

本研究共纳入46例二尖瓣疾病且接受单纯MVR的患者（平均年龄66±9.3岁）。使用连续方程测定二尖瓣有效瓣口面积（EOA），并根据患者体表面积进行指数化（EOAi）。PPM定义为EOAi≤1.2 cm2/m2。PH定义为收缩期肺动脉压（sPAP）>40 mmHg。同时进行临床和超声心动图随访。

结果

25%的患者存在PPM，但在比较有和没有PPM的患者时，基线和手术特征方面未观察到显著差异。大多数患者术后纽约心脏协会（NYHA）心功能分级得到改善。实际上，比较术前和术后超声心动图数据时，平均跨瓣压差（从8.6±2.8 mmHg降至5±1.3 mmHg，p = 0.001）、左心房内径（LAD）（从31.9±9.8 mm降至29.5±7 mm，p = 0.011）、左心室收缩末期直径（从42.6±18.1 mm降至35.5±6.6 mm，p = 0.044）和左心室舒张末期直径（从55.8±19.2 mm降至48.7±6.1 mm，p = 0.024）随时间均有显著下降。此外，在随访期（平均6.9±1.8年），所有患者的LAD（从31.9±9.8 mm降至28±11.1 mm，p = 0.001）、左心室舒张末期容积（从106.9±32.9 ml降至92.3±21.9 ml，p = 0.024）、三尖瓣反流（TR）（从87%降至27%，p = 0.002）和PH（从78.3%降至58.7%，p = 0.043）均有显著下降。有和没有PPM的患者在血流动力学、临床结局和心房利钠肽水平方面未观察到显著差异。