Minami Kimito, Kazawa Masahiro
Department of Critical Care Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
Gen Thorac Cardiovasc Surg. 2025 Jun;73(6):405-410. doi: 10.1007/s11748-024-02079-x. Epub 2024 Sep 13.
Patient-prosthesis mismatch (PPM) should be avoided during surgical aortic valve replacement because PPM would worsen the mortality and morbidity. Diagnosis of PPM could be made using various parameters measured by intraoperative transesophageal echocardiography. However, few studies have examined which parameters correlate most accurately between intraoperative and postoperative values.
This single-center prospective observational study analyzed 46 patients who underwent surgical aortic valve replacement (SAVR). Echocardiography was performed at the following 3-time points: preoperatively, intraoperatively, and 1 month postoperatively. The correlation between intraoperative and postoperative measurement values, including peak velocity (PV), mean pressure gradient (MPG), effective orifice area (EOA), and effective orifice area index (EOAI), were assessed using Pearson's correlation coefficient. Moreover, to evaluate whether a multivariable linear regression model with intraoperative and postoperative stroke volume added as an explanatory variable improves the correlation, the multiple correlation coefficients were calculated.
PV, MPG, EOA, and EOAI measured intraoperatively and 1 month postoperatively were significantly correlated. The r values of each measurement were 0.35, 0.344, 0.411 and 0.323, respectively. The multivariable linear regression model showed that the multiple correlation coefficients for MG and EOA were 0.491 and 0.663, respectively.
Intraoperative and postoperative PV, MPG, EOA, and EOAI were significantly correlated in patients undergoing SAVR with a bioprosthetic valve. The r value for EOA was 0.441, the largest among the measured values. Adjustment for stroke volume improved the strength of the correlation. Intraoperative evaluation of prosthetic valve function was considered most appropriate using EOA.
University Hospital Medical Information Network Clinical Trials Registry, registration number UMIN000046164, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052695 .
在外科主动脉瓣置换术中应避免人工瓣膜-患者不匹配（PPM），因为PPM会增加死亡率和发病率。PPM的诊断可通过术中经食管超声心动图测量的各种参数进行。然而，很少有研究探讨哪些参数在术中与术后值之间的相关性最为准确。
这项单中心前瞻性观察性研究分析了46例行外科主动脉瓣置换术（SAVR）的患者。在以下3个时间点进行超声心动图检查：术前、术中及术后1个月。使用Pearson相关系数评估术中与术后测量值之间的相关性，包括峰值流速（PV）、平均压力阶差（MPG）、有效瓣口面积（EOA）和有效瓣口面积指数（EOAI）。此外，为了评估将术中与术后每搏输出量作为解释变量纳入多变量线性回归模型是否能改善相关性，计算了复相关系数。
术中及术后1个月测量的PV、MPG、EOA和EOAI显著相关。各测量值的r值分别为0.35、0.344、0.411和0.323。多变量线性回归模型显示，MG和EOA的复相关系数分别为0.491和0.663。
在接受生物瓣置换的SAVR患者中，术中与术后的PV、MPG、EOA和EOAI显著相关。EOA的r值为0.441，是测量值中最大的。每搏输出量的校正提高了相关性强度。使用EOA被认为是术中评估人工瓣膜功能最合适的方法。
大学医院医学信息网络临床试验注册中心，注册号UMIN000046164，https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052695 。
