Ecemiş Yılmaz Bilge, Karacalılar Mehmet, Ersoy Burak, Onan Burak
Department of Cardiovascular Surgery, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Apr 24;27(2):143-151. doi: 10.5606/tgkdc.dergisi.2019.17174. eCollection 2019 Apr.
The aim of this study is to analyze the outcomes and incidence of postoperative patient-prothesis mismatch after surgical aortic valve replacement using supra-annular bioprosthesis and transcatheter aortic valve implantation.
Between January 2012 and June 2015, a total of 73 patients (37 males, 36 females; mean age 71.8±5.7 years; range, 65 to 82 years) who underwent either surgical aortic valve replacement using supraannular bioprosthesis (n=36) or transcatheter aortic valve implantation (n=37) were included. Postoperative patient-prothesis mismatch was defined as absent, mild-to-moderate, and severe, if the indexed effective orifice area was >0.85 cm/m, >0.65 to <0.85 cm/m, and <0.65 cm/m, respectively. Both groups were compared in terms of patient-prothesis mismatch, postoperative outcomes, and mortality.
The overall incidence of mild-to-moderate patient-prosthesis mismatch was 17.8% (13/73). No severe patient-prosthesis mismatch was observed. Mild-to-moderate patient-prosthesis mismatch was found in three patients (8.1%) in the transcatheter group and in 10 patients (27.8%) in the surgery group (p=0.035). Body surface area was the significant predictor of patient-prosthesis mismatch (p=0.007). Diameters of bioprosthetic valves in the surgery and transcatheter groups were 21.4±2 and 23.9±2.6 mm, respectively (p=0.002). Early mortality and pacemaker implantation rates were higher in the transcatheter group (p>0.05). Postoperative outcomes were similar between the groups. Mid-term mortality at a mean follow-up of 47.7±7.3 months was similar between the groups (p=0.158).
In high-risk patients with severe aortic stenosis, patientprosthesis mismatch is mild-to-moderate after surgical aortic valve replacement and transcatheter aortic valve implantation; however, this has no effect on early mortality. Based on our study results, we suggest that the use of surgical approach for aortic valve replacement may prevent potential complications of transcatheter aortic valve implantation.
本研究旨在分析使用超环生物假体进行外科主动脉瓣置换术和经导管主动脉瓣植入术后患者-假体不匹配的结果及发生率。
纳入2012年1月至2015年6月期间共73例患者（男性37例，女性36例；平均年龄71.8±5.7岁；范围65至82岁），这些患者接受了使用超环生物假体进行的外科主动脉瓣置换术（n = 36）或经导管主动脉瓣植入术（n = 37）。如果指数有效瓣口面积分别>0.85 cm/m²、>0.65至<0.85 cm/m²和<0.65 cm/m²，则术后患者-假体不匹配被定义为无、轻度至中度和重度。比较两组患者的患者-假体不匹配情况、术后结果和死亡率。
轻度至中度患者-假体不匹配的总体发生率为17.8%（13/73）。未观察到严重的患者-假体不匹配。经导管组有3例患者（8.1%）出现轻度至中度患者-假体不匹配，手术组有10例患者（27.8%）出现该情况（p = 0.035）。体表面积是患者-假体不匹配的重要预测因素（p = 0.007）。手术组和经导管组生物假体瓣膜的直径分别为21.4±2和23.9±2.6 mm（p = 0.002）。经导管组的早期死亡率和起搏器植入率较高（p>0.05）。两组术后结果相似。平均随访47.7±7.3个月时，两组的中期死亡率相似（p = 0.158）。
在重度主动脉瓣狭窄的高危患者中，外科主动脉瓣置换术和经导管主动脉瓣植入术后患者-假体不匹配为轻度至中度；然而，这对早期死亡率无影响。基于我们的研究结果，我们建议采用外科手术方法进行主动脉瓣置换术可能预防经导管主动脉瓣植入术的潜在并发症。
