The Early Clinical Results of Prosthesis-patient Mismatch after Aortic Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUHong-hao ¹ , YAOXing-xing ¹ , LISheng-bo ¹ , JIAOZhou-yang ¹ , XUjian-wei ² , GAOKe ² ,  LIUChao ¹

1. Department of Cardiac Surgery, Zhengzhou University, Zhengzhou 450052, P. R. China;
2. Department of Ultrasound, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, P. R. China;

Corresponding author：

LIUChao, Email: Liubeilun@sohu.com

Keywords：

Aortic valve replacement; Prosthesis-patient mismatch; Effective orifice area

DOI：

10.7507/1007-4848.20160031

Video：

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Objective To discuss the influence of early postoperative hemodynamic, postoperative mortality and the incidence of adverse cardiovascular events with the phenomenon of prosthesis-patient mismatch. Methods We retrospectively analyzed the clinical data of 89 patients who had simple aortic valve replacement in our hospital bewteen January 2012 and January 2014. The 89 patients were divided into two groups including a match group (16 females and 48 males with average age of 58.1±10.4 years) and a mismatch group (15 females and 10 males with average age of 65.3±12.8 years). We compared early results between the two groups. Results There is a statistic difference (P < 0.05) in aortic flow velocity, mean pressure gradient, and the maximum pressure gradient between the two groups. The survival rate of the match group is significantly lower than that of the mismatch group (P < 0.05). And there is a statistical difference in adverse cardiovascular event-free incidence between the two groups (P < 0.001). Conclusion The phenomenon of prosthesis-patient mismatch can affect postoperative hemodynamic and lead to heart failure after surgery. And early mortality and the incidence of cardiovascular adverse events in patients are increased due to prosthesis-patient mismatch.

Citation： LIUHong-hao, YAOXing-xing, LISheng-bo, JIAOZhou-yang, XUjian-wei, GAOKe, LIUChao. The Early Clinical Results of Prosthesis-patient Mismatch after Aortic Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(2): 137-141. doi: 10.7507/1007-4848.20160031 Copy

1.	Pereira JJ, Lager MS, Bashir M, et al. Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction. Am Coll Cardiol, 2002, 39(8): 1356-1363.
2.	Dumesnil JG, Pibarot P. Prevention of moderate prosthesis-patient mismatch: Individualization vs generalization. Rev Esp Cardiol, 2010, 63(4): 387-389.
3.	Vicchio M, Della A, De M, et al. Prosthesis-patient mismatch in the elderly:survival, ventricular mass regression, and quality of life. Ann Thorac Surg, 2008, 86(6): 1791-1797.
4.	李梁刚, 姜胜利, 高长青, 等. 老年主动脉瓣置换术的临床疗效分析. 贵阳医学院学报, 2014, 39(3): 416-418.
5.	Brownd JM, O'Brien SM, Wu C, et al. Isolated aortic valve replacement in North America comprising 108, 687 patients in 10 years: changes in risks, valve types, and outcomes in the society of thoracic surgeons national database.Thorac Cardiovasc Surg, 2009(1): 82-90.
6.	钱希明, 钟世镇. 主动脉瓣不匹配对老年病人术后生活质量的影响. 南方医科大学学报, 2009, 29(10): 2055-2063.
7.	Mohty D, Dmnesnil JG, Echahidi N, et al. Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesityand left ventrieular dysflmction. J Am Coil Cardiol, 2009, 53(2): 39-47.
8.	武忠, 王东进, 李捷, 等. 主动脉瓣置换术后人工心脏瓣膜-病人不匹配现象. 中华胸心血管外科杂志, 2010, 26(6): 374-376.
9.	Moon MR, Pasque MK, Munfakh NA, et al. Prosthesis-patient mismatch after aortic valve replacement: Impact on age and body size on late survival. Ann Thorac Surg, 2006, 81(2): 481-489.
10.	Pibarot P, Dumesnil JG.Prosthesis-patient mismatch: definition, clinical impact, and prevention.Heart, 2006, 92(8):1022-1029.
11.	解少强, 吴远林, 袁昕.主动脉瓣置换术患者人工瓣膜不匹配的影响因素分析. 临床合理用药, 2012, 5(5B): 30-31.
12.	Tasca G, Mhagna Z, Perotti S, et al. Impact of patient-prosthesis mismatch on cardiac events and midterm mortality after aortic valve replacement in patients with pure aortic stenosis. Circulation, 2006, 113(4): 570-576.
13.	张宝仁, 韩庆奇. 主动脉瓣置换术病人与人工瓣膜不匹配的影响与预防. 中华胸心血管外科杂志, 2010, 26(6):377-379.
14.	Pibarot P, Dumesnil JG, Lemieux M, et al.Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbi-dity and mortality after aortic valve replacement with a biopros-thetic heart valve. J Heart Valve Dis, 1998, 7(2): 211-218.
15.	Jessica A, Ditchfield MD, Granger E, et al. Aortic valve replacement in octogenarians. Heart, Lung and Circulation, 2014, 23(9): 841-846.
16.	舒礼良, 张竞超, 苏刚, 等. 主动脉瓣置换同期部分室间隔切除治疗重度主动脉瓣狭窄. 实用医学杂志, 2013, 29(21): 3621-3622.
17.	Moro E, D'Angelo G, Nicolosi G L, et al. Long-term evaluation of patients with apical hypertrophic cardiomyopathy. Correlation between quantitative echocardiographic assessment of apical hyper-trophy and clinical-electrocardio-graphic findings. Eur Heart J, 1995, 16(2): 210-217.
18.	Benedetto U, Melina G, Refice S, et al. Dual renin-angiotensin system blockade for patients with prosthesis-patient mismatch. Ann Thorac Surg, 2010, 90(6): 1899-1903.
19.	段宇龙, 徐敬, 苏刚, 等. β-受体阻滞剂对主动脉瓣置换术后心室内压力阶差的影响. 中国胸心血管外科临床杂志, 2011, 18(1): 35-39.
20.	刁明强, 董力, 江虹, 等. 心脏机械瓣置换术后早期抗凝的方法分析. 中国胸心血管外科临床杂志, 2006, 13(1): 10-13.

1. Pereira JJ, Lager MS, Bashir M, et al. Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction. Am Coll Cardiol, 2002, 39(8): 1356-1363.
2. Dumesnil JG, Pibarot P. Prevention of moderate prosthesis-patient mismatch: Individualization vs generalization. Rev Esp Cardiol, 2010, 63(4): 387-389.
3. Vicchio M, Della A, De M, et al. Prosthesis-patient mismatch in the elderly:survival, ventricular mass regression, and quality of life. Ann Thorac Surg, 2008, 86(6): 1791-1797.
4. 李梁刚, 姜胜利, 高长青, 等. 老年主动脉瓣置换术的临床疗效分析. 贵阳医学院学报, 2014, 39(3): 416-418.
5. Brownd JM, O'Brien SM, Wu C, et al. Isolated aortic valve replacement in North America comprising 108, 687 patients in 10 years: changes in risks, valve types, and outcomes in the society of thoracic surgeons national database.Thorac Cardiovasc Surg, 2009(1): 82-90.
6. 钱希明, 钟世镇. 主动脉瓣不匹配对老年病人术后生活质量的影响. 南方医科大学学报, 2009, 29(10): 2055-2063.
7. Mohty D, Dmnesnil JG, Echahidi N, et al. Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesityand left ventrieular dysflmction. J Am Coil Cardiol, 2009, 53(2): 39-47.
8. 武忠, 王东进, 李捷, 等. 主动脉瓣置换术后人工心脏瓣膜-病人不匹配现象. 中华胸心血管外科杂志, 2010, 26(6): 374-376.
9. Moon MR, Pasque MK, Munfakh NA, et al. Prosthesis-patient mismatch after aortic valve replacement: Impact on age and body size on late survival. Ann Thorac Surg, 2006, 81(2): 481-489.
10. Pibarot P, Dumesnil JG.Prosthesis-patient mismatch: definition, clinical impact, and prevention.Heart, 2006, 92(8):1022-1029.
11. 解少强, 吴远林, 袁昕.主动脉瓣置换术患者人工瓣膜不匹配的影响因素分析. 临床合理用药, 2012, 5(5B): 30-31.
12. Tasca G, Mhagna Z, Perotti S, et al. Impact of patient-prosthesis mismatch on cardiac events and midterm mortality after aortic valve replacement in patients with pure aortic stenosis. Circulation, 2006, 113(4): 570-576.
13. 张宝仁, 韩庆奇. 主动脉瓣置换术病人与人工瓣膜不匹配的影响与预防. 中华胸心血管外科杂志, 2010, 26(6):377-379.
14. Pibarot P, Dumesnil JG, Lemieux M, et al.Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbi-dity and mortality after aortic valve replacement with a biopros-thetic heart valve. J Heart Valve Dis, 1998, 7(2): 211-218.
15. Jessica A, Ditchfield MD, Granger E, et al. Aortic valve replacement in octogenarians. Heart, Lung and Circulation, 2014, 23(9): 841-846.
16. 舒礼良, 张竞超, 苏刚, 等. 主动脉瓣置换同期部分室间隔切除治疗重度主动脉瓣狭窄. 实用医学杂志, 2013, 29(21): 3621-3622.
17. Moro E, D'Angelo G, Nicolosi G L, et al. Long-term evaluation of patients with apical hypertrophic cardiomyopathy. Correlation between quantitative echocardiographic assessment of apical hyper-trophy and clinical-electrocardio-graphic findings. Eur Heart J, 1995, 16(2): 210-217.
18. Benedetto U, Melina G, Refice S, et al. Dual renin-angiotensin system blockade for patients with prosthesis-patient mismatch. Ann Thorac Surg, 2010, 90(6): 1899-1903.
19. 段宇龙, 徐敬, 苏刚, 等. β-受体阻滞剂对主动脉瓣置换术后心室内压力阶差的影响. 中国胸心血管外科临床杂志, 2011, 18(1): 35-39.
20. 刁明强, 董力, 江虹, 等. 心脏机械瓣置换术后早期抗凝的方法分析. 中国胸心血管外科临床杂志, 2006, 13(1): 10-13.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The Early Clinical Results of Prosthesis-patient Mismatch after Aortic Replacement

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