Kume Yuta, Fujita Tomoyuki, Fukushima Satsuki, Hata Hiroki, Shimahara Yusuke, Matsumoto Yorihiko, Yamashita Kizuku, Kobayashi Junjiro
Department of Cardiac Surgery, National Cerebral and Cardiovascular Center.
Circ J. 2017 Mar 24;81(4):468-475. doi: 10.1253/circj.CJ-16-0768. Epub 2017 Jan 27.
Prosthesis-patient mismatch (PPM) is associated with increased mid-term and long-term mortality rates after aortic valve replacement (AVR). This study aimed to evaluate the efficacy of the Carpentier-Edwards Perimount Magna and Magna Ease (CEPMs) aortic bioprostheses to reduce the incidence of PPM.
Altogether, 282 consecutive patients (113 women, mean age 69.9±9.9 years) underwent AVR with a CEPMs between 2008 and 2015. They were divided into 3 groups based on the risk of PPM as a result of their body surface area and aortic annular diameter (BSA/AnnD ratio): low-risk (LR) group: 0.64±0.05 m/cm (n=94); medium-risk (MR) group: 0.73±0.02 m/cm (n=94); high-risk (HR) group: 0.83±0.05 m/cm (n=94). The 30-day mortality rate was 0.4%. The 5-year actuarial survival rates were 93.2%, 92.3%, and 94.8% for groups LR, MR, and HR, respectively. No explants as a result of structural valve deterioration occurred. No patients showed severe PPM, defined as a measured effective orifice area index (EOAI) <0.65 cm/m. Although there were significant (P<0.05) differences in EOAI (0.98±0.2, 0.90±0.21, and 0.88±0.1 cm/mamong the LR, MR, and HR groups, respectively), the corresponding transvalvular mean pressure gradients (13.0±5.5, 12.3±4.0, 12.7±5.3 mmHg) and regression rates of the left ventricular mass (29.8%, 28.7%, 28.9%) were similar among groups.
CEPMs provide low surgical risk and reduce the risks of PPM, even in HR patients, with excellent hemodynamics.
人工瓣膜-患者不匹配（PPM）与主动脉瓣置换术（AVR）后中期和长期死亡率增加相关。本研究旨在评估Carpentier-Edwards Perimount Magna和Magna Ease（CEPMs）主动脉生物瓣膜降低PPM发生率的疗效。
2008年至2015年间，共有282例连续患者（113例女性，平均年龄69.9±9.9岁）接受了CEPMs主动脉瓣置换术。根据体表面积和主动脉瓣环直径导致的PPM风险将他们分为3组：低风险（LR）组：0.64±0.05 m/cm（n = 94）；中风险（MR）组：0.73±0.02 m/cm（n = 94）；高风险（HR）组：0.83±0.05 m/cm（n = 94）。30天死亡率为0.4%。LR、MR和HR组的5年精算生存率分别为93.2%、92.3%和94.8%。未发生因瓣膜结构恶化导致的瓣膜置换。没有患者出现严重PPM，即测量的有效瓣口面积指数（EOAI）<0.65 cm/m²。尽管LR、MR和HR组之间的EOAI存在显著（P<0.05）差异（分别为0.98±0.2、0.90±0.21和0.88±0.1 cm/m²），但相应的跨瓣平均压力梯度（13.0±5.5、12.3±4.0、12.7±5.3 mmHg）和左心室质量的回归率（29.8%、28.7%、28.9%）在各组之间相似。
CEPMs提供低手术风险，并降低PPM风险，即使在高风险患者中，血流动力学也良好。
