摘要目的 总结主动脉瓣置换术(AVR)中预防人工心脏瓣膜-患者不匹配(PPM)现象的措施和效果.方法 2010年2月至2011年12月,357例接受主动脉瓣置换术患者参照人工心脏瓣膜的有效开口面积(EOA)和患者的体表面积计算有效开口面积指数(EOAI),将EOAI ＞0.85 cm2/m2定义为不存在或仅有轻度的PPM,0.65≤EOAI≤0.85 cm2/m2定义为中度PPM,EOAI＜0.65 cm2/m2定义为重度PPM.术中采用“三步法”预防PPM.若患者主动脉瓣环过小,则采用以下3种方法:(1)主动脉瓣置换采用单针单线不带垫片间断缝合技术;(2)应用新型人工心脏瓣膜;(3)主动脉瓣环扩大手术.结果 357例AVR,置换机械瓣272例、生物瓣85例.本组49例AVR采用单针单线间断缝合法.38例应用新型人工心脏瓣膜,11例应用主动脉瓣环扩大手术.357例手术的PPM总发生率为6.4％,但无重度PPM发生.置换机械瓣的PPM发生率为1.8％,而生物瓣为21.2％.结论 AVR术中采取适当措施可以有效预防术后PPM现象的发生.

abstractsObjective The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size,thus causing valve prosthesis-patient mismatch (PPM).The aim of this article was to summarize the preventive strategy of PPM during AVR.Methods A total of 357 patients [203 males,154 females; mean age (54.9 ± 18.7 ) years ] underwent AVR between February.2010 and December 2011.The weight and body surface area (BSA) of the group is( 60.1 ± 11.4 )kg and (1.67 ± 0.21 )m2 respectively.The aortic valve prosthesis effective orifice area (EOA) was divided by body surface area (BSA) to obtain the EOA index (EOAI).PPM was then defined as none or mild if EOAI was ＞ 0.85 cm2/m2,as moderate for (0.65 - 0.85 ) cm2/m2 and as severe for ＜ 0.65 cm2/m2.To avoid PPM,a simple three-step algorithm was applied:Step 1,Calculate the patient's BSA from weight and height;Step 2,Calculate the minimal valve EOA required based on the BSA to ensure an EOAI ＞0.85 cm2/m2 ; Step 3,Select the type and size of prosthesis that has reference values for EOA greater or equal to the minimal EOA value obtained in step 2.For patients with a small aortic root,the following three methods was used:( 1 ) Replace aortic valve with simple interrupted suture technique ; (2) Apply new type and high-performance prosthetic valves such as St.Jude Medical Regent mechanical valve ; (3) Enlarge the narrowed aortic root when necessary.Results Of all 357 patients,272 patients received mechanical AVR and 85 bioprosthetic AVR.Among the 49 patients who received AVR with simple interrupted suture technique.St.Jude Medical Regent mechanical valve was implanted in 38 patients and the aortic root enlargement was performed in 11 patients.The total prevalence of PPM was 6.4％ and there was no severe PPM.The prevalence of PPM with mechanical AVR and bioprosthetic AVR was 1.8％ and 21.2％ respectively.There were 4 deaths during early period of operation,and the operative mortality was 1.1％.Conclusion Prosthesis-patient mismatch can be effectively prevented at the time of AVR with appropriate measurement.