Su Po-Hsueh, Chao Ting-Hsing, Huang Mu-Shiang, Tsai Wei-Chuan
Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University.
Division of Cardiology, Department of Internal Medicine, Madou Sin-Lau Hospital, Tainan, Taiwan.
Acta Cardiol Sin. 2024 Sep;40(5):595-607. doi: 10.6515/ACS.202409_40(5).20240207B.
Patient-prosthesis mismatch (PPM) after surgical aortic valve replacement for severe aortic stenosis has a significant effect on survival. Few studies have identified the risk factors for PPM and related outcomes. This study investigated these risk factors and clarified the outcomes.
This study enrolled consecutive patients who underwent aortic valve replacement surgery between January 2010 and June 2020 in our hospital. Data on clinical profiles, prosthesis types, echocardiographic parameters before and after surgery, and clinical outcomes including the composite of all-cause mortality and redo valve replacement were collected. We defined moderate and severe PPM as an effective orifice area index value of ≤ 0.85 and ≤ 0.65 cm/m, respectively, measured postoperatively through echocardiography. Potential risk factors for PPM and clinical outcomes were evaluated.
A total of 185 patients were enrolled. Body surface area (BSA; 1.68 ± 0.02 vs. 1.62 ± 0.01 m, p = 0.036), renal insufficiency (32.50% vs. 11.70%, p = 0.026), and aortic annulus diameter (1.99 ± 0.05 vs. 2.17 ± 0.03 cm, p = 0.013) were statistically significant risk factors for severe PPM. The primary outcome was observed in 30.00% and 15.86% of the patients with and without severe PPM, respectively (log-rank p = 0.023). Multivariate Cox proportional hazards analysis indicated that severe PPM was a risk factor for the primary outcome (hazard ratio: 2.688, 95% confidence interval: 1.094-6.622, p = 0.031).
Our study demonstrated that large BSA, renal insufficiency, and small annulus diameter were risk factors for severe PPM after aortic valve replacement surgery. Severe PPM was associated with worse clinical outcomes.
重度主动脉瓣狭窄患者接受外科主动脉瓣置换术后发生的人工瓣膜-患者不匹配（PPM）对生存有显著影响。很少有研究确定PPM的危险因素及相关结局。本研究对这些危险因素进行了调查并明确了结局。
本研究纳入了2010年1月至2020年6月期间在我院接受主动脉瓣置换手术的连续患者。收集了临床资料、人工瓣膜类型、手术前后的超声心动图参数以及包括全因死亡率和再次瓣膜置换在内的临床结局数据。我们将中度和重度PPM分别定义为术后经超声心动图测量的有效瓣口面积指数值≤0.85和≤0.65 cm/m²。对PPM和临床结局的潜在危险因素进行了评估。
共纳入185例患者。体表面积（BSA；1.68±0.02 vs. 1.62±0.01 m²，p = 0.036）、肾功能不全（32.50% vs. 11.70%，p = 0.026）和主动脉瓣环直径（1.99±0.05 vs. 2.17±0.03 cm，p = 0.013）是重度PPM的统计学显著危险因素。分别有30.00%和15.86%的有和无重度PPM的患者观察到主要结局（对数秩检验p = 0.023）。多因素Cox比例风险分析表明，重度PPM是主要结局的危险因素（风险比：2.688，95%置信区间：1.094 - 6.622，p = 0.031）。
我们的研究表明，较大的体表面积、肾功能不全和较小的瓣环直径是主动脉瓣置换术后重度PPM的危险因素。重度PPM与更差的临床结局相关。
