Compagnone Miriam, Marchetti Giulia, Taglieri Nevio, Ghetti Gabriele, Bruno Antonio Giulio, Orzalkiewicz Mateusz, Marrozzini Cinzia, Bacchi Reggiani Maria-Letizia, Palmerini Tullio, Galiè Nazzareno, Saia Francesco
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Int J Cardiol. 2020 Nov 1;318:27-31. doi: 10.1016/j.ijcard.2020.06.033. Epub 2020 Jul 5.
Incidence and long-term clinical consequences of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) are still unclear.
We enrolled 710 consecutive patients who underwent TAVR. PPM was defined as absent if the index orifice area (iEOA) was >0.85 cm2/m2, moderate if the iEOA was between 0.65 and 0.85 cm2/m2 or severe if the iEOA was <0.65 cm2/m2.
Among the 566 patients fulfilling the study criteria, the distribution of PPM was as follows: 50.5% none (n = 286), 43% moderate PPM (n = 243) and 6.5% severe PPM (n = 37). At 5-year follow-up, patients with severe PPM had a significantly higher incidence of the combined endpoint of cardiovascular death, acute myocardial infarction and stroke (p = .025) compared with the other patients. After adjusting the results for possible confounders, severe PPM remained an independent predictor of long-term adverse outcome (HR: 2.46; 95% Confidence Interval: 1.10-5.53). The independent predictors of severe PPM were valve-in-valve procedure and body mass index. Balloon-expandable valves were not associated with higher rates of severe PPM in comparison with self-expandable valves (8% vs. 5%, respectively, p = .245).
In our study severe PPM emerged as a risk factor for long-term major adverse cardiac and cerebrovascular events.
经导管主动脉瓣置换术（TAVR）后人工瓣膜与患者不匹配（PPM）的发生率及长期临床后果仍不明确。
我们纳入了710例连续接受TAVR的患者。如果指数开口面积（iEOA）>0.85 cm²/m²，则定义为无PPM；如果iEOA在0.65至0.85 cm²/m²之间，则定义为中度PPM；如果iEOA<0.65 cm²/m²，则定义为重度PPM。
在符合研究标准的566例患者中，PPM的分布如下：无PPM占50.5%（n = 286），中度PPM占43%（n = 243），重度PPM占6.5%（n = 37）。在5年随访中，与其他患者相比，重度PPM患者发生心血管死亡、急性心肌梗死和中风联合终点的发生率显著更高（p = 0.025）。在对可能的混杂因素进行结果调整后，重度PPM仍然是长期不良结局的独立预测因素（HR：2.46；95%置信区间：1.10 - 5.53）。重度PPM的独立预测因素是瓣中瓣手术和体重指数。与自膨胀瓣膜相比，球囊扩张瓣膜与重度PPM发生率较高无关（分别为8%和5%，p = 0.245）。
在我们的研究中，重度PPM是长期主要不良心脑血管事件的危险因素。
