Patient-prosthesis mismatch in mitral annuloplasty for degenerative mitral regurgitation: an ignored issue
Patient-prosthesis mismatch in mitral annuloplasty for degenerative mitral regurgitation: an ignored issue
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退行性二尖瓣反流二尖瓣环成形术中患者与假体不匹配：一个被忽视的问题
DOI：
10.1093/ejcts/ezz086
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发表时间：
2019-11-01
影响因子：
3.4
通讯作者：
Zhang, Wei
中科院分区：
文献类型：
--
作者：
Ma, Wenrui;Shi, Wei;Zhang, Wei
目的：二尖瓣修复术后，部分由小型瓣膜成形环引起的术后跨瓣压差（TMG）升高与晚期房颤（AF）相关。在这里，我们的目的是提供最佳的截止值的假体环的大小，以减少二尖瓣环成形术后的患者-假体不匹配（PPM）。方法：从2006年至2017年，262例患者接受二尖瓣修复退行性病变进行了回顾性研究。分别使用回归曲线和受试者操作特征曲线测试了体表面积（BSA）指数人工瓣口面积（POAi）-术后TMG和POAi-晚期AF的关系。POAi预测晚期AF的最佳截止值用于定义PPM。基线和随访数据的患者与无PPM进行了比较，在倾向评分匹配cohols.Results：住院死亡率为0。在中位随访3.8年期间，在9.2%（24/262）的患者中观察到晚期AF。POAi与术后TMG的关系符合指数模型（P < 0.001）。使用晚期AF作为因变量，PPM的最佳截止值为POAi
OBJECTIVES: Elevated postoperative transmitral gradient (TMG), partially induced by a small annuloplasty ring, is associated with late atrial fibrillation (AF) after mitral valve repair. Here, we aimed to provide the optimal cut-off of prosthetic ring size to reduce patient-prosthesis mismatch (PPM) after mitral annuloplasty.METHODS: From 2006 to 2017, 262 patients who underwent mitral valve repair for degenerative pathologies were retrospectively studied. The relationships of body surface area (BSA)-indexed prosthetic orifice area (POAi)-postoperative TMG and POAi-late AF were tested using regression curves and receiver operating characteristic curves, respectively. The optimal cut-off of POAi predictive of late AF was used to define PPM. Baseline and follow-up data of patients with and without PPM were compared in propensity score-matched cohorts.RESULTS: In-hospital mortality was 0. Late AF was observed in 9.2% (24/262) patients during a median follow-up of 3.8 years. An exponential model was best fitted based on the POAi-postoperative TMG relationship (P < 0.001). Using late AF as the dependent variable, the optimal cut-off for PPM was POAi