Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France.
Department of Cardiology, La Timone Hospital, 13005 Marseille, France.
Arch Cardiovasc Dis. 2021 Jun-Jul;114(6-7):504-514. doi: 10.1016/j.acvd.2020.11.005. Epub 2021 Jan 25.
Little is known about the effect of prosthesis-patient mismatch (PPM) on outcomes after transcatheter aortic valve replacement. We reported previously an increased risk of PPM with the SAPIEN 3 transcatheter heart valve (S3-THV).
To investigate the association of PPM with 1-year outcomes in patients with severe aortic stenosis (AS) implanted with S3-THV.
Moderate PPM was defined by an indexed effective orifice area (iEOA)≤0.85cm/m, and severe PPM by an iEOA<0.65cm/m. Inclusion criteria were severe symptomatic AS and implantation with S3-THV. The primary endpoint was hospitalization for congestive heart failure (CHF) at 1 year; the secondary endpoint was all-cause mortality.
A total of 208 consecutive patients were included between 2016 and 2018. Male sex was prevalent (53.8%), mean age was 81.9±6.2 years, mean EuroSCORE II was 4.35±3.37, mean LVEF was 57.9±13%. Moderate and severe PPM were observed in 69 (33.2%) and 10 (4.8%) patients. Patients with PPM were younger (80.4±7 vs 82.8±5.41 years; P=0.006), had a larger BSA (1.84±0.19 vs 1.77±0.19 m; P=0.01), a lower iEOA (0.73±0.08 vs 1.11±0.22 cm/m; P<0.001) and a higher mean gradient (14±4.6 vs 11.9±3.9mmHg; P<0.001). CHF occurred in 16.5% vs 7% (P=0.03). By multivariable analysis, PPM was independently associated with CHF (hazard ratio [HR] 3.17, 95% confidence interval [CI] 1.17 to 8.55; P=0.032), especially in patients with mitral regurgitation≥2/4 (HR>100, 95%CI>100 to>1000; P<0.01). PPM did not correlate with all-cause mortality (HR 0.90, 95%CI 0.22 to 3.03; P=0.86).
PPM after S3-THV implantation is strongly associated with CHF at 1 year, but is not correlated with overall mortality.
关于假体-患者不匹配（PPM）对经导管主动脉瓣置换术后结果的影响知之甚少。我们之前报道过，使用 SAPIEN 3 经导管心脏瓣膜（S3-THV）会增加 PPM 的风险。
研究 S3-THV 植入的严重主动脉瓣狭窄（AS）患者的 PPM 与 1 年结局的关系。
中度 PPM 的定义为指数有效瓣口面积（iEOA）≤0.85cm/m，重度 PPM 的定义为 iEOA<0.65cm/m。纳入标准为严重有症状的 AS 并植入 S3-THV。主要终点为 1 年内因充血性心力衰竭（CHF）住院；次要终点为全因死亡率。
2016 年至 2018 年期间共纳入 208 例连续患者。男性居多（53.8%），平均年龄 81.9±6.2 岁，平均 EuroSCORE II 为 4.35±3.37，平均左心室射血分数（LVEF）为 57.9±13%。69 例（33.2%）和 10 例（4.8%）患者出现中度和重度 PPM。PPM 患者年龄较小（80.4±7 岁 vs 82.8±5.41 岁；P=0.006），BSA 较大（1.84±0.19 vs 1.77±0.19 m；P=0.01），iEOA 较小（0.73±0.08 vs 1.11±0.22 cm/m；P<0.001），平均梯度较高（14±4.6 vs 11.9±3.9mmHg；P<0.001）。CHF 发生率为 16.5% vs 7%（P=0.03）。多变量分析显示，PPM 与 CHF 独立相关（风险比 [HR] 3.17，95%置信区间 [CI] 1.17 至 8.55；P=0.032），尤其是在二尖瓣反流≥2/4（HR>100，95%CI>100 至>1000；P<0.01）的患者中。PPM 与全因死亡率无关（HR 0.90，95%CI 0.22 至 3.03；P=0.86）。
S3-THV 植入后 PPM 与 1 年时的 CHF 密切相关，但与总体死亡率无关。
