经导管主动脉瓣置换术后人工瓣膜-患者不匹配风险的Meta分析被引量：2

The risk of prosthetic mismatch after transcatheter aortic valve implantation:a meta analysis

下载PDF

导出

摘要目的人工瓣膜-患者不匹配(Prosthesis-patient mismatch,PPM)使左心室后负荷增加,影响瓣膜置换术后患者临床转归。本研究通过Meta分析探讨经导管主动脉瓣置换(transcatheter aortic valve implantation,TAVI)术后PPM的危险因素。方法搜索Medline、Cochrane图书馆、Scopus数据库,选择有关TAVI术后PPM的研究。选择以是否发生PPM而分组比较的队列研究纳入Meta分析。结果 PPM患者平均体表面积1.87±0.202平方米(m2),年龄78.3±7.78岁,左室射血分数41.0±14.1%,有效开瓣面积指数0.366±0.0922,相较无PPM患者,差异有统计学显著意义(P<0.05)。性别、体重指数、冠脉搭桥手术史、NYHA分级、LogisticEuroscore,以及术前心脏彩超结果之主动脉瓣环大小、主动脉瓣跨瓣压等因素,两组间无显著差异(P>0.05)。结论较大的体表面积、较低的左室射血分数、术前更严重的主动脉瓣狭窄程度与TAVI术后PPM的发生相关。 ObjectiveProsthesis-patient mismatch （PPM） leads to increased left ventricle afterload and influences the clinical outcome of postoperative patients. This Meta analysis aims to study risk factors of prosthesis-patient mismatch （PPM） after transcatheter aortic valve implantation （TAVI）. MethodsThe data of prosthesis-patient mismatch after transcatheter aortic valve implantation was derived by searching Medline, Cochrane library, Scopus database. Studies with baseline data of PPM group and no PPM group were included in the Meta analysis. ResultsPPM patients had averaged body surface area of 1.87±0.202 m2,.age of 78.3±7.78 years old,.left ventricle ejection fraction of 41.0±14.1%,.effective orifice area index of 0.366±0.0922..Comparing with no PPM group,.PPM patients had larger body surface area,.lower left ventricle ejection fraction and lower effective orifice area （P〈0.05）..No significant statistical differences of the other factors were found,.including sex,.body metabolic index,.preoperative acute myocardial infarction,history of coronary artery bypass graft,.NYHA grade,logistic EuroSCORE,transvalvular gradient,aortic annulus diameter（P〉0.05）. ConclusionLarger body surface area,lower left ventricle ejection fraction and more severe aortic stenosis are related to PPM.

作者王萌傅钢兰江慧琦曾宽华平徐忠东

机构地区中山大学孙逸仙纪念医院心胸外科中山大学孙逸仙纪念医院麻醉科

出处《岭南现代临床外科》 2014年第2期160-164,共5页 Lingnan Modern Clinics in Surgery

基金广东省科技计划项目(编号:2009B060700039)

关键词经导管主动脉瓣置换术人工瓣膜-患者不匹配 META分析 Transcatheteraortie valve implantation （TAVI） Prosthesis-patient mismatch （PPM） Meta analysis

分类号 R654.2 [医药卫生—外科学]

引文网络
相关文献

参考文献12

1Rahimtoola SH. The problem of valve prosthesis-patient mismatch [J]. Circulation, 1978, 58(1): 20-24.
2Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention [J]. J Am Coil Cardiol, 2000, 36(4): 1131- 1141.
3Seiffert M, Conradi L, Baldus S, et al. Impact of patient- prosthesis mismatch after transcatheter aortic valve-in-valve implantation in degenerated bioprostheses [J]. J Thorac Cardiovasc Surg, 2012, 143(3): 617-624.
4Tzikas A, Piazza N, Geleijnse ML, et al. Prosthesis-patient mismatch after transcatheter aortic valve implantation with the medtronic CoreValve system in patients with aortic stenosis [J]. Am J Cardiol, 2010, 106(2): 255-260.
5Tuzcu EM, Ozkan A, Kapadia SR. Prosthesis-patient mismatch in the transcatheter aortic valve replacement era [J]. J Am Coil Cardiol, 2011, 58( 18): 1919-1922.
6Ewe SH, Muratori M, Delgado V, et al. Hemodynamic and clinical impact of prosthesis-patient mismatch after transcatheter aortic valve implantation [J]. J Am Coil Cardiol, 2011, 58(18): 1910-1918.
7Munoz-Garcia AJ, Munoz-Garcia M, Carrasco-Chinchilla F, et al. Incidence and clinical outcome of prosthesis-patient mismatch after transcatheter aortic valve implantation with the CoreValve prosthesis [J]. Int J Cardiol, 2013, 167(3): 1074-1076.
8Blais C, Dumesnil JG, Baillot R, et al. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement [J]. Circulation, 2003, 108 (8) : 983- 988.
9Bleiziffer S, Ali A, Hettich IM, et al. Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement [ J ]. Heart, 2010, 96 ( 11 ) : 865- 871.
10Mohty D, Dumesnil JG, Echahidi N, et al. Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement : influence of age, obesity, and left ventricular dysfunction [J]. J Am Coil Cardiol, 2009, 53 ( 1 ) : 39-47.