Fazmin Ibrahim Talal, Ali Jason M
Royal Papworth Hospital, Cambridge CB2 0AY, UK.
J Cardiovasc Dev Dis. 2023 Sep 1;10(9):373. doi: 10.3390/jcdd10090373.
Prosthesis-patient mismatch (PPM) is defined as implanting a prosthetic that is insufficiently sized for the patient receiving it. PPM leads to high residual transvalvular gradients post-aortic valve replacement and consequently results in left ventricular dysfunction, morbidity and mortality in both the short and long term. Younger patients and patients with poor preoperative left ventricular function are more vulnerable to increased mortality secondary to PPM. There is debate over the measurement of valvular effective orifice area (EOA) and variation exists in how manufacturers report the EOA. The most reliable technique is using in vivo echocardiographic measurements to create tables of predicted EOAs for different valve sizes. PPM can be prevented surgically in patients at risk through aortic root enlargement (ARE). Established techniques include the posterior enlargement through Nicks and Manouguian procedures, and aortico-ventriculoplasty with the Konno-Rastan procedure, which allows for a greater enlargement but carries increased surgical risk. A contemporary development is the Yang procedure, which uses a Y-shaped incision created through the non- and left-coronary cusp commissure, undermining the nadirs of the non- and left-coronary cusps. Early results are promising and demonstrate an ability to safely increase the aortic root by up to two to three sizes. Aortic root enlargement thus remains a valuable and safe tool in addressing PPM, and should be considered during surgical planning.
人工瓣膜-患者不匹配（PPM）定义为植入尺寸对于接受该瓣膜的患者而言过小的人工瓣膜。PPM会导致主动脉瓣置换术后出现较高的残余跨瓣压差，进而导致左心室功能障碍，以及短期和长期的发病率和死亡率升高。年轻患者和术前左心室功能较差的患者更容易因PPM导致死亡率增加。关于瓣膜有效瓣口面积（EOA）的测量存在争议，并且制造商报告EOA的方式也存在差异。最可靠的技术是使用体内超声心动图测量来创建不同瓣膜尺寸的预测EOA表格。对于有风险的患者，可通过主动脉根部扩大术（ARE）手术预防PPM。已有的技术包括通过尼克斯（Nicks）和马努吉安（Manouguian）手术进行后部扩大，以及采用康诺-拉斯坦（Konno-Rastan）手术进行主动脉心室成形术，后者可实现更大程度的扩大，但手术风险增加。一种当代的进展是杨式手术，该手术通过无冠瓣和左冠瓣交界处以Y形切口，潜行分离无冠瓣和左冠瓣的最低点。早期结果很有前景，表明能够安全地将主动脉根部扩大两到三个尺寸。因此，主动脉根部扩大术仍然是解决PPM的一种有价值且安全的手段，在手术规划时应予以考虑。
