Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Interact Cardiovasc Thorac Surg. 2020 Aug 1;31(2):152-157. doi: 10.1093/icvts/ivaa085.
The issue of prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) has been a controversial topic. We sought to evaluate the long-term clinical impacts of PPM in patients undergoing SAVR in an updated, homogeneous cohort.
Using the prospective institutional database, we identified 895 adult patients (median age 66, interquartile range 58-72; 45.6% women) who underwent isolated SAVR from January 2000 to March 2016. Those with pure aortic insufficiency and concomitant other cardiac operations were excluded from this study cohort. The presence of a significant PPM was defined as an indexed effective orifice area 0.85 cm2/m2 or less. The outcome of interest was all-cause deaths. Propensity score matching was performed for adjusting bias.
Significant PPM was present in 247 patients (27.6%). During the follow-up period (mean 71.2 ± 51.04 months), 134 patients (15%) died. Survival rates at 10 and 15 years were 78.3% vs 83.8% and 71.3% vs 57.6% in the PPM and non-PPM groups (P = 0.972). Risk factor analysis indicated that developing PPM was not associated with a risk of death. After propensity score matching (1:1), developing PPM was not a risk factor for long-term death as well (P = 0.584).
Significant PPM was common after SAVR in patients with aortic stenosis. However, there was no significant difference in survival rate between those with and without PPM.
主动脉瓣置换术（SAVR）后假体-患者不匹配（PPM）的问题一直存在争议。我们试图在更新的同质队列中评估 SAVR 患者 PPM 的长期临床影响。
使用前瞻性机构数据库，我们从 2000 年 1 月至 2016 年 3 月期间确定了 895 名接受单纯 SAVR 的成年患者（中位数年龄 66 岁，四分位间距 58-72 岁；45.6%为女性）。本研究队列排除了单纯主动脉瓣关闭不全和同时进行其他心脏手术的患者。存在显著 PPM 的定义为指数有效瓣口面积 0.85 cm2/m2 或更小。研究终点为全因死亡。采用倾向评分匹配法调整偏倚。
247 例（27.6%）患者存在显著 PPM。在随访期间（平均 71.2±51.04 个月），134 例（15%）患者死亡。PPM 组和非 PPM 组 10 年和 15 年的生存率分别为 78.3%比 83.8%和 71.3%比 57.6%（P=0.972）。风险因素分析表明，发生 PPM 与死亡风险无关。经倾向评分匹配（1:1）后，发生 PPM 也不是长期死亡的危险因素（P=0.584）。
主动脉瓣狭窄患者 SAVR 后 PPM 很常见。然而，有和没有 PPM 的患者的生存率没有显著差异。
