当代小型机械瓣膜假体中的患者-假体不匹配对10年生存率无影响。

Patient-Prosthesis Mismatch in Contemporary Small-Size Mechanical Prostheses Does Not Impact Survival at 10 Years.

作者信息

Feier Horea, Mocan Mihaela, Grigorescu Andrei, Falnita Lucian, Gaspar Marian, Luca Constantin-Tudor

机构信息

Department of Cardiology, University of Medicine and Pharmacy "Victor Babes" Timisoara, 300041 Timisoara, Romania.

Research Center of the Institute for Cardiovascular Diseases, 300310 Timisoara, Romania.

出版信息

J Cardiovasc Dev Dis. 2022 Jan 31;9(2):48. doi: 10.3390/jcdd9020048.

BACKGROUND

The effect of PPM in mechanical prostheses on long-term survival is not well-established.

METHODS

Patients who received a 21 mm or smaller aortic valve between 2000 and 2011 were retrospectively analyzed ( = 416). Propensity matching was used in order to account for baseline differences in patient subgroups (PPM vs. no PPM; severe PPM vs. no severe PPM).

RESULTS

Five- and ten-year survival was 78 ± 3.52% and 64.51 ± 4.51% in patients with PPM, versus 83.3 ± 3.12% and 69.37 ± 4.36% in patients without ( = 0.28) when analyzed at 10.39 ± 5.25 years after the primary procedure. Independent risk factors for impaired survival, after matching, were age, serum creatinine, and severe pulmonary hypertension. Five- and ten-year survival in patients with severe PPM was 73.34 ± 6.01% and 61.76 ± 8.17%, respectively, versus 74.72 ± 5.68% and 67.50 ± 7.09% in those without ( = 0.49), at 8.82 ± 5.17 years after SAVR. Age was the only independent variable that influenced long-term survival when severe PPM was added to the model.

CONCLUSIONS

PPM or severe PPM does not impact long-term survival up to 10 years in mechanical valve recipients when matching for preoperative variables.

背景

机械瓣膜中瓣周漏（PPM）对长期生存的影响尚未明确。

方法

对2000年至2011年间接受21毫米或更小主动脉瓣置换的患者进行回顾性分析（n = 416）。采用倾向匹配法以考虑患者亚组间的基线差异（有PPM与无PPM；重度PPM与无重度PPM）。

结果

在初次手术后10.39±5.25年进行分析时，有PPM患者的5年和10年生存率分别为78±3.52%和64.51±4.51%，无PPM患者分别为83.3±3.12%和69.37±4.36%（P = 0.28）。匹配后，生存受损的独立危险因素为年龄、血清肌酐和重度肺动脉高压。重度PPM患者在主动脉瓣置换术后8.82±5.17年时的5年和10年生存率分别为73.34±6.01%和61.76±8.17%，无重度PPM患者分别为74.72±5.68%和67.50±7.09%（P = 0.49）。当将重度PPM纳入模型时，年龄是影响长期生存的唯一独立变量。