Aboul-Hassan Sleiman Sebastian, Stankowski Tomasz, Marczak Jakub, Cichon Romuald
Department of Cardiac Surgery, MEDINET Heart Center Ltd, Nowa Sol, Poland.
Department of Cardiac Surgery, Sana-Heart Center Cottbus, Cottbus, Germany.
Interact Cardiovasc Thorac Surg. 2018 Jun 1;26(6):1027-1034. doi: 10.1093/icvts/ivx426.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patient-prosthesis mismatch (PPM) has a negative impact on patients undergoing mitral valve replacement in terms of postoperative mortality, incidence of postoperative pulmonary hypertension (PH) and higher transmitral gradients. Altogether 103 papers were found using the reported search, 18 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Overall, 8 studies with a total of 4812 patients reported that PPM has a significantly negative impact on long-term mortality, whereas 5 studies with a total of 1558 patients reported no effect on mortality. One study with a total of 2440 patients reported preoperative PH as the risk factor for increased mortality in the presence of moderate or severe PPM. Three studies evaluated the effect of PPM on postoperative PH and reported that PPM was associated with significantly increased postoperative PH. The majority of the studies reported that PPM was associated with higher peak or mean transmitral gradient and systolic pulmonary artery pressure. The results presented in these studies suggest that PPM in patients undergoing mitral valve replacement was associated with increased postoperative mean and peak transmitral gradient and higher postoperative systolic pulmonary artery pressure. PPM may be associated with increased long-term mortality. Severe PPM was directly associated with increased long-term mortality when compared with moderate or no PPM. Evidence suggests that PPM is associated with increased incidence of postoperative PH.
根据结构化方案撰写了一篇心脏外科的最佳证据主题。所探讨的问题是，就术后死亡率、术后肺动脉高压（PH）发生率以及更高的二尖瓣跨瓣压差而言，患者-人工瓣膜不匹配（PPM）是否会对接受二尖瓣置换术的患者产生负面影响。通过报告的检索共找到103篇论文，其中18篇代表了回答该临床问题的最佳证据。现将这些论文的作者、期刊、发表日期、国家、所研究的患者组、研究类型、相关结局和结果制成表格。总体而言，8项研究共纳入4812例患者，报告PPM对长期死亡率有显著负面影响；而5项研究共纳入1558例患者，报告对死亡率无影响。一项共纳入2440例患者的研究报告，术前PH是存在中度或重度PPM时死亡率增加的危险因素。3项研究评估了PPM对术后PH的影响，报告PPM与术后PH显著增加相关。大多数研究报告PPM与更高的二尖瓣峰值或平均跨瓣压差以及收缩期肺动脉压相关。这些研究呈现的结果表明，接受二尖瓣置换术患者的PPM与术后平均和峰值二尖瓣跨瓣压差增加以及术后收缩期肺动脉压升高相关。PPM可能与长期死亡率增加相关。与中度或无PPM相比，重度PPM与长期死亡率增加直接相关。有证据表明PPM与术后PH发生率增加相关。
