Pińska Małgorzata, Sorysz Danuta, Frączek-Jucha Magdalena, Stąpór Maciej, Golińska-Grzybała Karolina, Nessler Jadwiga, Gackowski Andrzej
Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
The John Paul II Hospital, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2023 Jun;19(2):152-157. doi: 10.5114/aic.2023.129214. Epub 2023 Jun 30.
The treatment of choice for aortic stenosis is a valve replacement. Some patients have post-procedural increased pressure gradient on the implanted prosthesis because of patient-prosthesis mismatch (PPM), known to adversely influence prognosis. The PPM risk should be initially predicted and effort made to avoid this complication, specifically in large body size patients.
To assess the frequency of PPM taking into account the valvular prosthesis type in a real-life population of consecutive patients included in the Krakow aortic stenosis registry.
The KRAK-AS registry was conducted in July-October 2016. Patients were assessed before and after valve surgery and during the 3-year follow-up. Patients who underwent aortic valve intervention were clinically and echocardiographically evaluated within a month after surgery and divided into groups depending on the implanted prosthesis type. Analysis of patients with a smaller (< 23 mm) and larger than median (≥ 23 mm) valve diameter was performed.
The valve implantation was performed in 229 patients (42 mechanical, 139 biological, 48 transcatheter). No differences between patient groups compared by PPM occurrence was seen at baseline. Median age was 70 years; 55.5% were men. At least moderate PPM (iEOA ≤ 0.85 cm/m) was observed in 40% of mechanical valves, 33% of biological valves, and was significantly less frequent (10%) in patients after transcatheter valve implantation, = 0.0001. Severe PPM (iEOA < 0.65 cm/m) was found in 17.6% of mechanical valve PPM patients, 4.3% of biological ones, and no patients after transcatheter procedure.
PPM is a frequent phenomenon in the real-life population of patients undergoing surgical aortic valve replacement, being significantly less frequent in the case of a transcatheter procedure.
主动脉瓣狭窄的首选治疗方法是瓣膜置换。一些患者由于患者-人工瓣膜不匹配（PPM），术后人工瓣膜上的压力梯度增加，已知这会对预后产生不利影响。应首先预测PPM风险，并努力避免这种并发症，特别是在体型较大的患者中。
在克拉科夫主动脉瓣狭窄登记处纳入的连续患者的真实人群中，评估考虑人工瓣膜类型的PPM发生率。
KRAK-AS登记处于2016年7月至10月进行。在瓣膜手术前后以及3年随访期间对患者进行评估。接受主动脉瓣介入治疗的患者在术后1个月内进行临床和超声心动图评估，并根据植入的人工瓣膜类型分组。对瓣膜直径小于中位数（<23mm）和大于中位数（≥23mm）的患者进行分析。
229例患者接受了瓣膜植入（42例机械瓣膜，139例生物瓣膜，48例经导管瓣膜）。在基线时，按PPM发生率比较的患者组之间未见差异。中位年龄为70岁；55.5%为男性。在40%的机械瓣膜、33%的生物瓣膜中观察到至少中度PPM（iEOA≤0.85cm/m²），而在经导管瓣膜植入术后患者中频率显著较低（10%），P = 0.0001。在机械瓣膜PPM患者中，17.6%发现严重PPM（iEOA<0.65cm/m²），生物瓣膜患者中为4.3%，经导管手术患者中未发现。
PPM在接受外科主动脉瓣置换的真实患者人群中是一种常见现象，在经导管手术的情况下频率显著较低。
