Yoshida Kazuki, Sasaki Haruka, Takaoka Hiroyuki, Matsumoto Moe, Nishikawa Yusei, Noguchi Yoshitada, Aoki Shuhei, Suzuki Katsuya, Yashima Satomi, Kinoshita Makiko, Suzuki-Eguchi Noriko, Takanashi Shuichiro, Matsushita Kazuyuki, Matsumiya Goro, Kobayashi Yoshio
Department of Laboratory Medicine, Chiba University Hospital, Chiba 260-8677, Japan.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan.
J Clin Med. 2025 Jul 5;14(13):4762. doi: 10.3390/jcm14134762.
: Prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) is known to be a poor prognostic factor. However, the parameters for preventing postoperative PPM in SAVR have not been established. : Two hundred and five patients (mean age 72.5 ± 7.4 years, 129 males) who underwent SAVR were analyzed. Preoperatively, we determined the recommended prosthesis valve size from the mean aortic valve (AV) diameter derived from the AV annulus area by preoperative three-dimensional transesophageal echocardiography (3D-TEE). We investigated the association between pre- and postoperative changes in annulus diameter and the occurrence of PPM. : PPM was present in 6 patients (2.9%). Pre- and postoperative AV annulus diameter change ratio was greater in the group with PPM than in that without PPM (10.4 ± 3.6% vs. 3.0 ± 5.6%, = 0.002). The use of prosthetic valve rings smaller than the recommended size was higher in the group with PPM than in that without PPM. (83.3% vs. 20.6%, = 0.002). On multivariate logistic regression analysis, use of a valve smaller than the recommended size was an independent predictor of PPM (odds ratio 19.3, 95% confidence interval 2.14-174.5, = 0.008). : The recommended prosthetic AV size based on preoperative 3D-TEE is useful for determining the optimal prosthetic AV size to prevent PPM after SAVR.
在外科主动脉瓣置换术（SAVR）中，人工瓣膜 - 患者不匹配（PPM）是一个不良预后因素。然而，SAVR术后预防PPM的参数尚未确立。对205例行SAVR的患者（平均年龄72.5±7.4岁，男性129例）进行分析。术前，通过术前三维经食管超声心动图（3D - TEE）从主动脉瓣环面积得出的平均主动脉瓣（AV）直径确定推荐的人工瓣膜尺寸。我们研究了瓣环直径术前和术后变化与PPM发生之间的关联。6例患者（2.9%）存在PPM。PPM组的术前和术后AV瓣环直径变化率高于无PPM组（10.4±3.6%对3.0±5.6%，P = 0.002）。PPM组使用小于推荐尺寸的人工瓣膜环的比例高于无PPM组（83.3%对20.6%，P = 0.002）。多因素逻辑回归分析显示，使用小于推荐尺寸的瓣膜是PPM的独立预测因素（比值比19.3，95%置信区间2.14 - 174.5，P = 0.008）。基于术前3D - TEE推荐的人工AV尺寸有助于确定预防SAVR术后PPM的最佳人工AV尺寸。
