| Autor: |
Moon, Marc R., Pasque, Michael K., Munfakh, Nabil A., Melby, Spencer J., Lawton, Jennifer S., Moazami, Nader, Codd, John E., Crabtree, Traves D., Barner, Hendrick B., Damiano, Ralph J. |
| Předmět: |
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| Zdroj: |
Annals of Thoracic Surgery; Feb2006, Vol. 81 Issue 2, p481-489, 9p |
| Abstrakt: |
Background: The purpose of this study was to identify patient subgroups in which prosthesis-patient mismatch most influenced late survival. Methods: Over a 12-year period, 1,400 consecutive patients underwent bioprosthetic (933 patients) or mechanical (467) aortic valve replacement. Prosthesis-patient mismatch was defined as prosthetic effective orifice area/body surface area less than 0.75 cm2/m2 and was present with 11% mechanical and 51% bioprosthetic valves. Results: With bioprosthetic valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 68% ± 7% mismatch versus 75% ± 7% no mismatch, p< 0.02) but not older patients (p= 0.47). Similarly, with mechanical valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 62% ± 11% versus 79% ± 4%, p < 0.005) but not older patients (p = 0.26). For small patients (body surface area less than 1.7 m2), prosthesis-patient mismatch did not impact survival with bioprosthetic (p = 0.32) or mechanical (p= 0.71) valves. For average-size patients (body surface area 1.7 to 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with both bioprosthetic (p < 0.05) and mechanical (p< 0.005) valves. For large patients (body surface area greater than 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with mechanical (p< 0.04) but not bioprosthetic (p= 0.40) valves. Conclusions: Prosthesis-patient mismatch had a negative impact on survival for young patients, but its impact on older patients was minimal. In addition, although prosthesis-patient mismatch was not important in small patients, prosthesis-patient mismatch negatively impacted survival for average-size patients and for large patients with mechanical valves. [Copyright &y& Elsevier] |
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