CAJ | 학술논문

目的观察术后早期中度瓣膜-患者不匹配现象(prosthesis-patient mismatch,PPM)对应用17 mm St.Jude Medical Regent(SJMR)行主动脉瓣置换术后患者中远期临床效果的影响,并探讨患者个体因素与PPM影响效果的关系.方法我们对106例应用17 mm SJMR行主动脉瓣置换术的患者进行随访,于术前、出院时及术后29～ 74个月,平均(48.6±11.9)个月,评估患者术后临床指标和Regent瓣膜在体血流动力学参数变化.结果围手术期死亡比例2.8％,术后1、3、5年免于心脏不良事件相关死亡比例分别为98.1％、95.9％、88.2％.其中45例(43.7％)患者在术后院内末次超声心动图评估发现合并中度PPM.随访期间,患者NYHA心功能分级、主动脉瓣跨瓣压差及左心室质量指数均较术前明显改善,合并中度PPM患者与非PPM患者在各临床指标与血流动力学参数之间并无明显差异.但在术前左心功能受损的患者中(左心室射血分数＜0.50),中度PPM会显著增加此亚组患者中远期死亡比例(HR 1.46,P=0.02).多因素回归分析发现,糖尿病与左心室射血分数＜0.35是导致全组患者术后中远期死亡比例增加的独立危险因素.结论 17 mm SJMR主动脉瓣置换术后早期出现的中度PPM与左心功能受损患者术后中远期死亡比例增加密切相关.合理选择小主动脉瓣环患者接受17 mm SJMR瓣膜的置入能取得满意的中远期临床效果.
목적 관찰술후조기중도판막-환자불필배현상(prosthesis-patient mismatch,PPM)대응용17 mm St.Jude Medical Regent(SJMR)행주동맥판치환술후환자중원기림상효과적영향,병탐토환자개체인소여PPM영향효과적관계.방법 아문대106례응용17 mm SJMR행주동맥판치환술적환자진행수방,우술전、출원시급술후29～ 74개월,평균(48.6±11.9)개월,평고환자술후림상지표화Regent판막재체혈류동역학삼수변화.결과 위수술기사망비례2.8％,술후1、3、5년면우심장불량사건상관사망비례분별위98.1％、95.9％、88.2％.기중45례(43.7％)환자재술후원내말차초성심동도평고발현합병중도PPM.수방기간,환자NYHA심공능분급、주동맥판과판압차급좌심실질량지수균교술전명현개선,합병중도PPM환자여비PPM환자재각림상지표여혈류동역학삼수지간병무명현차이.단재술전좌심공능수손적환자중(좌심실사혈분수＜0.50),중도PPM회현저증가차아조환자중원기사망비례(HR 1.46,P=0.02).다인소회귀분석발현,당뇨병여좌심실사혈분수＜0.35시도치전조환자술후중원기사망비례증가적독립위험인소.결론 17 mm SJMR주동맥판치환술후조기출현적중도PPM여좌심공능수손환자술후중원기사망비례증가밀절상관.합리선택소주동맥판배환자접수17 mm SJMR판막적치입능취득만의적중원기림상효과.
Objective The study was designed to evaluate the effects of moderate prosthesis-patient mismatch(PPM) on midterm outcomes after aortic valve replacement(AVR) with the 17 mm St.Jude Medical Regent valve in a large series of patients,and to determine if these effects are modulated by patient' s confounding variables.Methods Methods One-hundred and six patients with and without moderate PPM after implantation of a 17 mm Regent valve at aortic position were included.Both clinical and echocardiographic assessments were performed preoperatively,at discharge and at follow-up,mean follow-up (42.6 ± 15.9) months.Results The prevalence of moderate PPM was documented in 45 patients(43.7％) at discharge.During the follow-up,no difference in the regression of left ventricular mass,decrease of transvalvular pressure gradients,mortality and valve-related complications was observed between patients with and without moderate PPM.After adjustment for several risk factors,moderate PPM was associated with increased midterm mortality in a subgroup of patients with baseline left ventricular ejection fraction ＜ 0.50 (HR 1.46,P =0.02),but with normal prognosis in those with preserved ventricular function.Conclusion Moderate PPM after AVR with a small mechanical prosthesis is associated with increased mortality and complications in patients with pre-existing LV dysfunction.Selected patients with small aortic annulus can experience satisfactory clinical improvements and midterm survival after AVR with 17 mm Regent valve.