Tomšič Anton, Arabkhani Bardia, Schoones Jan W, Etnel Jonathan R G, Marsan Nina A, Klautz Robert J M, Palmen Meindert
Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands.
J Card Surg. 2020 Dec;35(12):3477-3485. doi: 10.1111/jocs.15108. Epub 2020 Oct 21.
The hemodynamic effect and early and late survival impact of prosthesis-patient mismatch (PPM) after mitral valve replacement remains insufficiently explored.
Pubmed, Embase, Web of Science, and Cochrane Library databases were searched for English language original publications. The search yielded 791 potentially relevant studies. The final review and analysis included 19 studies compromising 11,675 patients.
Prosthetic effective orifice area was calculated with the continuity equation method in 7 (37%), pressure half-time method in 2 (10%), and partially or fully obtained from referenced values in 10 (53%) studies. Risk factors for PPM included gender (male), diabetes mellitus, chronic renal disease, and the use of bioprostheses. When pooling unadjusted data, PPM was associated with higher perioperative (odds ratio [OR]: 1.66; 95% confidence interval [CI]: 1.32-2.10; p < .001) and late mortality (hazard ratio [HR]: 1.46; 95% CI: 1.21-1.77; p < .001). Moreover, PPM was associated with higher late mortality when Cox proportional-hazards regression (HR: 1.97; 95% CI: 1.57-2.47; p < .001) and propensity score (HR: 1.99; 95% CI: 1.34-2.95; p < .001) adjusted data were pooled. Contrarily, moderate (HR: 1.01; 95% CI: 0.84-1.22; p = .88) or severe (HR: 1.19; 95% CI: 0.89-1.58; p = .24) PPM were not related to higher late mortality when adjusted data were pooled individually. PPM was associated with higher systolic pulmonary pressures (mean difference: 7.88 mmHg; 95% CI: 4.72-11.05; p < .001) and less pulmonary hypertension regression (OR: 5.78; 95% CI: 3.33-10.05; p < .001) late after surgery.
Mitral valve PPM is associated with higher postoperative pulmonary artery pressure and might impair perioperative and overall survival. The relation should be further assessed in properly designed studies.
二尖瓣置换术后人工瓣膜-患者不匹配（PPM）的血流动力学效应以及对早期和晚期生存的影响仍未得到充分研究。
检索了PubMed、Embase、Web of Science和Cochrane图书馆数据库中的英文原始出版物。检索结果得到791项可能相关的研究。最终的综述和分析纳入了19项研究，共11675例患者。
7项（37%）研究采用连续方程法计算人工瓣膜有效瓣口面积，2项（10%）采用压力减半时间法，10项（53%）研究部分或完全从参考值中获取。PPM的危险因素包括性别（男性）、糖尿病、慢性肾病以及生物瓣膜的使用。汇总未调整数据时，PPM与较高的围手术期死亡率（比值比[OR]：1.66；95%置信区间[CI]：1.32 - 2.10；p <.001）和晚期死亡率（风险比[HR]：1.46；95% CI：1.21 - 1.77；p <.001）相关。此外，汇总Cox比例风险回归（HR：1.97；95% CI：1.57 - 2.47；p <.001）和倾向评分（HR：1.99；95% CI：1.34 - 2.95；p <.001）调整后的数据时，PPM与较高的晚期死亡率相关。相反，单独汇总调整后的数据时，中度（HR：1.01；95% CI：0.84 - 1.22；p = 0.88）或重度（HR：1.19；95% CI：0.89 - 1.58；p = 0.24）PPM与较高的晚期死亡率无关。PPM与术后晚期较高的收缩期肺动脉压（平均差值：7.88 mmHg；95% CI：4.72 - 11.05；p <.001）以及较少的肺动脉高压缓解（OR：5.78；95% CI：3.33 - 10.05；p <.001）相关。
二尖瓣PPM与术后较高的肺动脉压相关，可能损害围手术期和总体生存。这种关系应在设计合理的研究中进一步评估。
