Madeira Márcio, Ranchordás Sara, Oliveira Paulo, Nolasco Tiago, Marques Marta, Sousa-Uva Miguel, Abecasis Miguel, Neves José
Cardiothoracic surgery, Hospital de Santa Cruz - Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.
Rev Port Cir Cardiotorac Vasc. 2019 Apr-Jun;26(2):101-107.
The goal of this study is to establish the relation between aortic bio prosthesis, patient prosthesis mismatch (PPM) and short-term mortality and morbidity as well as and long-term mortality.
This is a single center retrospective study with 812 patients that underwent isolated stented biologic aortic valve replacement between 2007 and 2016. The projected indexed orifice area was calculated using the in vivo previously published values. Outcomes were evaluated with the indexed effective orifice area (iEOA) as a continuous variable and/or nominal variable. Multivariable models were developed including clinically relevant co-variates.
In the study population 65.9% (n=535) had no PPM, 32.6% (n=265) had moderate PPM and 1.5% (n=12) severe PPM. PPM was related with diabetes (OR:1.738, CI95:1.333-2.266; p<0.001), heart failure (OR:0.387, CI95:0.155-0.969; p=0.043) and older age (OR:1.494, CI95:1.171-1.907; p=0.001). iEOA was not an independent predictor of in-hospital mortality (OR 1.169, CI 0.039-35.441) or MACCE (OR 2.753, CI 0.287-26.453). Long term survival is significantly inferior with lower iEOA (HR 0.116, CI 0.041-0.332) and any degree of PPM decreases survival when compared with no PPM (Moderate: HR 1.542, CI 1.174-2.025; Severe HR 4.627, CI 2.083-10.276).
PPM appears to have no impact on short-term outcomes including mortality and morbidity. At ten years follow-up, moderate or severe PPM significantly reduces the long-term survival.
本研究的目的是确定主动脉生物假体、患者-假体不匹配（PPM）与短期死亡率和发病率以及长期死亡率之间的关系。
这是一项单中心回顾性研究，研究对象为2007年至2016年间接受孤立性带支架生物主动脉瓣置换术的812例患者。使用先前发表的体内值计算预计的指数化瓣口面积。以指数化有效瓣口面积（iEOA）作为连续变量和/或名义变量评估结果。建立了包括临床相关协变量的多变量模型。
在研究人群中，65.9%（n = 535）无PPM，32.6%（n = 265）有中度PPM，1.5%（n = 12）有重度PPM。PPM与糖尿病（OR：1.738，95%CI：1.333 - 2.266；p < 0.001）、心力衰竭（OR：0.387，95%CI：0.155 - 0.969；p = 0.043）和高龄（OR：1.494，95%CI：1.171 - 1.907；p = 0.001）相关。iEOA不是住院死亡率（OR 1.169，CI 0.039 - 35.441）或主要不良心血管和脑血管事件（MACCE，OR 2.753，CI 0.287 - 26.453）的独立预测因素。iEOA较低时长期生存率显著较低（HR 0.116，CI 0.041 - 0.332），与无PPM相比，任何程度的PPM都会降低生存率（中度：HR 1.542，CI 1.174 - 2.025；重度HR 4.627，CI 2.083 - 10.276）。
PPM似乎对包括死亡率和发病率在内的短期结局没有影响。在十年随访中，中度或重度PPM会显著降低长期生存率。
