主动脉瓣及二尖瓣机械瓣联合置换术后瓣膜不匹配现象的临床研究

Study of valve prosthesis-patient mismatch in patients underwent combined mitral and aortic valve replacement with mechanical valve

目的:探讨主动脉瓣及二尖瓣机械瓣联合置换术后人工心脏瓣膜-患者不匹配(VP-PM)现象的发生率及其与术前患者情况及预后的关系。方法:比较患者术后瓣膜有效开口面积指数(EOAi)与血流速度的关系。明确不同VP-PM状态患者一般情况及预后有无差异。结果:本研究共纳入729例患者,主动脉瓣中重度VP-PM发生率高于二尖瓣(20.94%vs2.74%)。双瓣均为重度VP-PM患者的身高、体重及体表面积均大于单瓣VP-PM或无VP-PM患者。双瓣均为中重度VP-PM组患者住院期间肾功能衰竭发生率、死亡率显著高于单瓣中重度VP-PM及无VP-PM患者。结论:(1)双瓣置换术后易出现主动脉瓣VP-PM;(2)双瓣均出现VP-PM患者体重及体表面积较大;(3)术后双瓣均为中重度VP-PM患者的死亡率及肾功能衰竭发生率高。

Objective To evaluate the incidence of valve prosthesis-patient mismatch（VP-PM）in patients underwent combined AVR and MVR,and explore the relationship between VP-PM and patient＇ s baseline characteristic,hospital mortality and risk of acute renal dysfunction.Methods Evaluated the baseline in different patients according the degree of VP-PM,and analyzed the effect of VP-PM on hospital mortality and risk of acute renal dysfunction.Results A total of 729 patients were retrospectively evaluated.The number of patients with moderate to severe aortic VP-PM are more than that with mitral valve VP-PM（20.94% vs 2.74%）.Patients with moderate to severe VP-PM in both aortic and mitral valve had more height,body weight and body surface area than that of others.Patients with severe VP-PM of both aortic and mitral valve had higher hospital mortality and more risk of acute renal dysfunction（18.2%）than that of the other patients.Conclusions（1）The incidence of aortic VPPM is higher than that of mitral VP-PM in patients with combined AVR and MVR.（2）Except for body weight and body surface area,patients with combined aortic and mitral moderate to severe VP-PM shows no baseline characteristic difference.（3）Patients with moderate to severe VP-PM in both aortic and mitral valve have higher hospital mortality and incidence of acute renal dysfunction.