Amorim Paulo A, Diab Mahmoud, Walther Mario, Färber Gloria, Hagendorff Andreas, Bonow Robert O, Doenst Torsten
Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany.
Department of Basic Sciences, University of Applied Sciences Jena, Jena, Germany.
Thorac Cardiovasc Surg. 2020 Oct;68(7):550-556. doi: 10.1055/s-0038-1676814. Epub 2019 Jan 4.
Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) may affect survival but data are conflicting. It is assessed by relating effective orifice area (EOA) to body surface area (EOAi). EOA is patient-specific as the result of flow-velocity times area at the individual patient's outflow tract levels (LVOT) divided by trans-prosthetic flow velocity. However, some studies use projected EOAs (i.e., valve size associated EOAs from other patient populations) to assess how PPM affects outcome.
We analyzed 76 studies addressing hemodynamic outcome and/or mortality after bioprosthetic AVR.
In 48 studies, projected or measured EOA for calculation of EOAi and PPM assessment was used (of which 25 demonstrated an effect on survival). We identified 28 additional studies providing measured EOA values and the corresponding Bernoulli's pressure gradients after AVR. Despite EOA being a patient-specific parameter, 77% of studies assessing a PPM impact on survival used projected EOAs. The 28 studies are providing measured EOA values and the corresponding Bernoulli's pressure gradients in patients after AVR showed a highly significant, linear relationship between EOA and Bernoulli's gradient. Considering this relationship, it is surprising that relating EOA to body surface area (BSA) (EOAi) is standard but relating pressure gradients to BSA is not.
We conclude that the majority of studies assessing PPM have used false assumptions because EOA is a patient-specific parameter and cannot be transferred to other patients. In addition, the use of EOAi to assess PPM may not be appropriate and could explain the inconsistent relation between PPM and survival in previous studies.
主动脉瓣置换术（AVR）后人工瓣膜-患者不匹配（PPM）可能影响生存率，但数据存在矛盾。它通过将有效瓣口面积（EOA）与体表面积（EOAi）相关联来评估。EOA是患者特异性的，其结果是个体患者流出道水平（LVOT）处的流速乘以面积再除以人工瓣膜跨瓣流速。然而，一些研究使用预计的EOA（即来自其他患者群体的与瓣膜大小相关的EOA）来评估PPM如何影响预后。
我们分析了76项关于生物人工瓣膜AVR后血流动力学结果和/或死亡率的研究。
在48项研究中，使用预计的或测量的EOA来计算EOAi和评估PPM（其中25项显示对生存率有影响）。我们另外确定了28项研究，这些研究提供了AVR后测量的EOA值和相应的伯努利压力梯度。尽管EOA是患者特异性参数，但评估PPM对生存率影响的研究中有77%使用了预计的EOA。这28项提供AVR后患者测量的EOA值和相应伯努利压力梯度的研究表明，EOA与伯努利梯度之间存在高度显著的线性关系。考虑到这种关系，令人惊讶的是，将EOA与体表面积（BSA）相关联（EOAi）是标准做法，但将压力梯度与BSA相关联却不是。
我们得出结论，大多数评估PPM的研究使用了错误的假设，因为EOA是患者特异性参数，不能应用于其他患者。此外，使用EOAi评估PPM可能不合适，这可以解释先前研究中PPM与生存率之间不一致的关系。
