Catalano Michael A, Rutkin Bruce, Koss Elana, Maurer Greg, Berg Jacinda, Hartman Alan, Yu Pey-Jen
Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA.
J Card Surg. 2021 Jan;36(1):191-196. doi: 10.1111/jocs.15148. Epub 2020 Nov 10.
Patient-prosthesis mismatch (PPM) is associated with poor outcomes after aortic valve replacement. The aim of this study was to assess the accuracy of indexed effective orifice area (EOAi) charts in predicting PPM after transcatheter aortic valve replacement (TAVR).
A retrospective review of 346 TAVR patients from January 2017 to November 2018 was performed. EOAi was predicted for patients based on published predictive tables using valve type, annulus diameter, and body surface area. Actual EOAi was calculated based on intraoperative transesophageal echocardiogram (TEE) measurements. PPM was defined by EOAi ≤ 0.85 cm /m . The accuracy of predicted PPM was assessed. Differences in clinical outcomes, including mean gradient, length of stay, mortality, complications, and change in Kansas City cardiomyopathy questionnaire score as an indicator of quality of life, were evaluated based on actual PPM.
Of the 346 patients analyzed, 44 (12.7%) of patients had PPM on intraoperative TEE. Of the 182 patients who received Sapien 3 valves, 42 (23.1%) were predicted to have PPM while 25 (13.7%) had actual PPM. Of the 164 patients who received Evolut valves, 3 (1.8%) were predicted to have PPM while 19 (11.6%) had actual PPM. EOAi charts had poor sensitivity (40.0% for Sapien 3; 5.25% for Evolut) and positive predictive value (23.8% for Sapien 3; 33.3% for Evolut) for both valve types.
Preoperative prediction of PPM in TAVR patients using tables of expected EOA demonstrates significant variation from actual PPM. The utility of EOAi charts to predict PPM in patients undergoing TAVR may be limited.
人工瓣膜与患者不匹配（PPM）与主动脉瓣置换术后不良预后相关。本研究旨在评估经导管主动脉瓣置换术（TAVR）后，指数化有效瓣口面积（EOAi）图表预测PPM的准确性。
对2017年1月至2018年11月期间的346例TAVR患者进行回顾性研究。根据已发表的预测表，利用瓣膜类型、瓣环直径和体表面积为患者预测EOAi。实际EOAi根据术中经食管超声心动图（TEE）测量值计算得出。PPM定义为EOAi≤0.85 cm²/m²。评估预测PPM的准确性。根据实际PPM评估临床结局的差异，包括平均压差、住院时间、死亡率、并发症以及作为生活质量指标的堪萨斯城心肌病问卷评分的变化。
在分析的346例患者中，44例（12.7%）患者在术中TEE检查时存在PPM。在182例接受Sapien 3瓣膜的患者中，42例（23.1%）被预测存在PPM，而25例（13.7%）实际存在PPM。在164例接受Evolut瓣膜的患者中，3例（1.8%）被预测存在PPM，而19例（11.6%）实际存在PPM。两种瓣膜类型的EOAi图表敏感性（Sapien 3为40.0%；Evolut为5.25%）和阳性预测值（Sapien 3为23.8%；Evolut为33.3%）均较低。
使用预期EOA表对TAVR患者进行PPM的术前预测与实际PPM存在显著差异。EOAi图表在预测接受TAVR患者的PPM方面的效用可能有限。
