Department of Cardiothoracic Surgery University of Pittsburgh PA USA.
University of Pittsburgh Medical Center UPMC Heart and Vascular Institute Pittsburgh PA USA.
J Am Heart Assoc. 2024 Apr 2;13(7):e033176. doi: 10.1161/JAHA.123.033176. Epub 2024 Mar 27.
It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions.
We performed a systematic review with meta-analysis of reconstructed time-to-event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Sixty-five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow-up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio [HR], 1.16 [95% CI, 1.13-1.18], <0.001). At 20 years of follow-up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 [95% CI, 1.06-1.11], <0.001; severe versus no PPM: HR, 1.29 [95% CI, 1.24-1.35], <0.001). PPM was associated with higher risk of cardiac death, heart failure-related hospitalizations, and aortic valve reinterventions over time (<0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta-regression analysis revealed that populations with more women tend to have higher HRs for all-cause death associated with PPM.
The results of the present study suggest that any degree of PPM is associated with poorer long-term outcomes following surgical aortic valve replacement and provide support for implementation of preventive strategies to avoid PPM after surgical aortic valve replacement.
人工瓣膜-患者不匹配（PPM）是否会影响主动脉瓣置换术后的长期结果仍存在争议。我们旨在评估 PPM 与死亡率、再住院率和主动脉瓣再介入的关系。
我们对截至 2023 年 3 月发表的研究进行了系统回顾和荟萃分析，这些研究使用了重构的时间事件数据（根据系统评价和荟萃分析的首选报告项目）。65 项研究符合我们的入选标准，包括 122989 名患者（任何 PPM：68332 名患者，55.6%）。在 25 年的随访中，有和没有任何 PPM 的患者的生存率分别为 11.8%和 20.6%（风险比[HR]，1.16[95%可信区间，1.13-1.18]，<0.001）。在 20 年的随访中，没有、中度和重度 PPM 的患者的生存率分别为 19.5%、12.1%和 8.8%（中度 PPM 与无 PPM：HR，1.09[95%可信区间，1.06-1.11]，<0.001；重度 PPM 与无 PPM：HR，1.29[95%可信区间，1.24-1.35]，<0.001）。PPM 与心脏死亡、心力衰竭相关住院和主动脉瓣再介入的风险随着时间的推移而增加（<0.001）。无论瓣膜类型（生物瓣与机械瓣）、未经调整和根据体重指数调整的当代 PPM 定义以及 PPM 量化方法（体外、体内、多普勒超声心动图），都观察到 PPM 与较差的生存率之间存在统计学显著关联。我们的元回归分析表明，女性比例较高的人群与 PPM 相关的全因死亡的 HR 较高。
本研究结果表明，任何程度的 PPM 与主动脉瓣置换术后的长期预后较差相关，并为实施预防策略以避免主动脉瓣置换术后的 PPM 提供了支持。
