Cardiac Imaging Department, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
Laboratorio de Estadística Aplicada a las Ciencias de la Salud (LEACS), Departamento de Toxicología y Farmacología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.
Echocardiography. 2021 Jun;38(6):814-824. doi: 10.1111/echo.15068. Epub 2021 May 15.
To evaluate the accuracy of predicted prosthesis-patient mismatch (PPM) regarding actual PPM measured postoperatively. To assess the association between PPM and prosthetic valve dysfunction.
Retrospective cohort study including adult patients after aortic valve replacement surgery with a biological prosthesis. Predicted PPM status was determined using mean reference effective orifice area indexed to total body surface (iEOA), without considering reference standard deviations. Postoperative PPM status was determined by measuring iEOA within the first 60 postoperative days. Prosthetic valve dysfunction was defined as thrombosis, pannus, valve degeneration, and/or disruption.
205 patients were enrolled between January 2003 and June 2017: predicted PPM was absent in 52 patients (25.4%), moderate in 137 patients (66.8%), and severe in 16 patients (7.8%). After surgery, the actual postoperative iEOA was measured: 53 (25.9%) did not have PPM, 73 had moderate PPM (35.6%), and 79 had severe PPM (38.5%). Predicted PPM identified the presence of hemodynamically significant actual postoperative PPM (OR = 2.56; 95%CI 1.30-5.05; P = .006), though not its degree of severity. Prosthetic valve dysfunction was more frequent among patients with hemodynamically significant PPM (53.9% vs. 11.3%; P < .001), compared to those without PPM. The association between PPM and prosthetic valve dysfunction was maintained after adjusting for gender, age, and ever-smoking (OR = 9.03; P < .001). The incidence of thrombosis or pannus was also nonsignificantly higher in patients with moderate or severe PPM.
Predicted PPM identifies the presence, possibly not the severity, of actual postoperative PPM. Moderate or severe PPM is associated with prosthetic valve dysfunction. Actual postoperative prosthesis-patient mismatch measured within 60 postoperative days showed a distinctive hemodynamic profile and presented a stronger association with prosthetic valve dysfunction than predicted prosthesis-patient mismatch. A. Echocardiographic follow-up in patients according to the actual postoperative PPM measured within 60 postoperative days. B. Prediction of prosthetic valve dysfunction based on preoperative predicted PPM or on actual postoperative PPM within 60 postoperative days. PPM: prosthesis-patient mismatch. OR: Odds ratio.
评估预测的人工假体-患者不匹配（PPM）与术后实际 PPM 测量值之间的准确性。评估 PPM 与人工瓣膜功能障碍之间的关系。
本回顾性队列研究纳入了接受主动脉瓣置换术的成人患者，使用生物假体。通过测量术后 60 天内的 iEOA 来确定术后 PPM 状态，而不考虑参考标准偏差。使用平均参考有效瓣口面积指数化（iEOA）来确定预测性 PPM 状态，不考虑参考标准偏差。使用平均参考有效瓣口面积指数化（iEOA）来确定预测性 PPM 状态，不考虑参考标准偏差。人工瓣膜功能障碍定义为血栓形成、瓣叶赘生物、瓣膜退化和/或破裂。
205 例患者于 2003 年 1 月至 2017 年 6 月间纳入研究：52 例（25.4%）无预测性 PPM，137 例（66.8%）为中度 PPM，16 例（7.8%）为重度 PPM。术后测量实际术后 iEOA：53 例（25.9%）无 PPM，73 例为中度 PPM（35.6%），79 例为重度 PPM（38.5%）。预测性 PPM 可识别存在有临床意义的实际术后 PPM（OR=2.56；95%CI 1.30-5.05；P=0.006），但不能识别其严重程度。与无 PPM 相比，人工瓣膜功能障碍在存在有临床意义的 PPM 患者中更为常见（53.9% vs. 11.3%；P<0.001）。在调整性别、年龄和吸烟史后，PPM 与人工瓣膜功能障碍之间的关联仍然存在（OR=9.03；P<0.001）。在中度或重度 PPM 患者中，血栓形成或瓣叶赘生物的发生率也无显著升高。
预测性 PPM 可识别实际术后 PPM 的存在，可能无法识别其严重程度。中度或重度 PPM 与人工瓣膜功能障碍有关。在术后 60 天内测量的实际术后假体-患者不匹配可显示出独特的血流动力学特征，与人工瓣膜功能障碍的相关性比预测性假体-患者不匹配更强。A. 根据术后 60 天内测量的实际 PPM，对患者进行超声心动图随访。B. 根据术前预测性 PPM 或术后 60 天内的实际 PPM 预测人工瓣膜功能障碍。PPM：假体-患者不匹配。OR：比值比。
