Advertisement

Patienten-Prothesen-Mismatch nach Aortenklappenersatz

  • Sabine BleizifferEmail author
Chapter
  • 588 Downloads

Zusammenfassung

Der Begriff „Patienten-Prothesen-Mismatch“ bezeichnet das Phänomen, dass eine Aortenklappenprothese „zu klein“ für den Patient ist. Dieses Phänomen wurde erstmals 1978 von SH Rahimtoola erkannt und beschrieben (Rahimtoola 1978). Unter der Überlegung, dass nach Implantation einer Aortenklappenprothese die Öffnungsfläche kleiner ist als die einer natürlichen Klappe, nahm er an, dass bei einer bestimmten Anzahl von Patienten der erforderliche Blutfluss durch eine reduzierte Öffnungsfläche nur durch Erhöhung der Flussgeschwindigkeit und damit des Gradienten aufrechterhalten werden kann. Ob diese nachteilige Hämodynamik einen Einfluss auf das Überleben und die Morbidität nach Aortenklappenersatz hat, wird seitdem intensiv diskutiert.

Literatur

  1. Ali A, Halstead JC, Cafferty F, Sharples L, Rose F, Coulden R et al (2006) Are stentless valves superior to modern stented valves? A prospective randomized trial. Circulation 114:I535–I540PubMedGoogle Scholar
  2. Bach DS, Metras J, Doty JR, Yun KL, Dumesnil JG, Kon ND (2007) Freedom from structural valve deterioration among patients aged < or = 60 years undergoing Freestyle stentless aortic valve replacement. J Heart Valve Dis 16:649–655PubMedGoogle Scholar
  3. Badano LP, Pavoni D, Musumeci S, Frassani R, Gianfagna P, Baldassi M et al (2006) Stented bioprosthetic valve hemodynamics: is the supra-annular implant better than the intra-annular? J Heart Valve Dis 15:238–246PubMedGoogle Scholar
  4. Bakhtiary F, Schiemann M, Dzemali O, Wittlinger T, Doss M, Ackermann H et al (2006) Stentless bioprostheses improve postoperative coronary flow more than stented prostheses after valve replacement for aortic stenosis. J Thorac Cardiovasc Surg 131:883–888PubMedGoogle Scholar
  5. Bakhtiary F, Schiemann M, Dzemali O, Dogan S, Schachinger V, Ackermann H et al (2007) Impact of patient-prosthesis mismatch and aortic valve design on coronary flow reserve after aortic valve replacement. J Am Coll Cardiol 49:790–796PubMedGoogle Scholar
  6. Blackstone EH, Cosgrove DM, Jamieson WR, Birkmeyer NJ, Lemmer JH Jr, Miller DC et al (2003) Prosthesis size and long-term survival after aortic valve replacement. J Thorac Cardiovasc Surg 126:783–796PubMedGoogle Scholar
  7. Bleiziffer S, Eichinger WB, Hettich I, Guenzinger R, Ruzicka D, Bauernschmitt R, Lange R (2007) Prediction of valve prosthesis-patient mismatch prior to aortic valve replacement: which is the best method? Heart 93:615–620PubMedGoogle Scholar
  8. Bleiziffer S, Eichinger WB, Hettich I, Ruzicka DJ, Wottke M, Bauernschmitt R, Lange R (2008) Impact of prosthesis-patient mismatch on exercise capacity in patients after bioprosthetic aortic valve replacement. Heart 94:637–641PubMedGoogle Scholar
  9. Bleiziffer S, Ali A, Hettich IM, Akdere D, Laubender RP, Ruzicka D, Boehm J, Lange R, Eichinger W (2010) Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement. Heart 96:865–867PubMedGoogle Scholar
  10. Bonow RO, Carabello BA, Kanu C, de Leon AC Jr, Faxon DP, Freed MD et al (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114:e84–e231PubMedGoogle Scholar
  11. Botzenhardt F, Eichinger WB, Bleiziffer S, Guenzinger R, Wagner IM, Bauernschmitt R, Lange R (2006) Hemodynamic comparison of bioprostheses for complete supra-annular position in patients with small aortic annulus. J Am Coll Cardiol. 45(12):2054– 2060.Google Scholar
  12. Bove T, Van Belleghem Y, Francois K, Caes F, Van Overbeke H, Van Nooten G (2006) Stentless and stented aortic valve replacement in elderly patients: Factors affecting midterm clinical and hemodynamical outcome. Eur J Cardiothorac Surg 30:706–713PubMedGoogle Scholar
  13. Ding WH, Lam YY, Pepper JR, Kaya MG, Li W, Chung R, Henein MY (2010) Early and long-term survival after aortic valve replacement in septuagenarians and octogenarians with severe aortic stenosis. Int J Cardiol 141:24–31PubMedGoogle Scholar
  14. DuBois D, DuBois EF (1916) A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 17:863–871Google Scholar
  15. Ennker J, Rosendahl U, Albert A, Dumlu E, Ennker IC, Florath I (2005) Stentless bioprostheses in small aortic roots: impact of patient-prosthesis mismatch on survival and quality of life. J Heart Valve Dis 14:523–530PubMedGoogle Scholar
  16. Fuster RG, Montero Argudo JA, Albarova OG, Sos FH, Lopez SC et al (2005) Patient-prosthesis mismatch in aortic valve replacement: really tolerable? Eur J Cardiothorac Surg 27:441–449PubMedGoogle Scholar
  17. Gulbins H, Florath I, Ennker J (2008) Cerebrovascular events after stentless aortic valve replacement during a 9-year follow-up period. Ann Thorac Surg 86:769–773PubMedGoogle Scholar
  18. Howell NJ, Keogh BE, Barnet V, Bonser RS, Graham TR, Rooney SJ, Wilson IC, Pagano D (2006) Patient-prosthesis mismatch does not affect survival following aortic valve replacement. Eur J Cardiothorac Surg 30:10–14PubMedGoogle Scholar
  19. Kleine P, Perthel M, Hasenkam JM, Nygaard H, Hansen SB, Laas J (2000) High-intensity transient signals (HITS) as a parameter for optimum orientation of mechanical aortic valves. Thorac Cardiovasc Surg 48:360–363PubMedGoogle Scholar
  20. Koch CG, Khandwala F, Estafanous FG, Loop FD, Blackstone EH (2005) Impact of prosthesis-patient size on functional recovery after aortic valve replacement. Circulation 111:3221–3229PubMedGoogle Scholar
  21. Kohsaka S, Mohan S, Virani S, Lee VV, Contreras A, Reul GJ, Coulter SA (2008) Prosthesis-patient mismatch affects long-term survival after mechanical valve replacement. J Thorac Cardiovasc Surg 135:1076–1080PubMedGoogle Scholar
  22. Mannacio VA, De Amicis V, Di Tommaso L, Iorio F, Vosa C (2009) Influence of prosthesis-patient mismatch on exercise-induced arrhythmias: a further aspect after aortic valve replacement. J Thorac Cardiovasc Surg 138:632–638PubMedGoogle Scholar
  23. Mascherbauer J, Rosenhek R, Fuchs C, Pernicka E, Klaar U, Scholten C et al (2008) Moderate patient-prosthesis mismatch after valve replacement for severe aortic stenosis has no impact on short-term and long-term mortality. Heart 94:1639–1645PubMedGoogle Scholar
  24. Medalion B, Blackstone EH, Lytle BW, White J, Arnold JH, Cosgrove DM (2000) Aortic valve replacement: is valve size important? J Thorac Cardiovasc Surg 119:963–974PubMedGoogle Scholar
  25. Milano AD, De Carlo M, Mecozzi G, D’Alfonso A, Scioti G, Nardi C, Bortolotti U (2002) Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-up. Ann Thorac Surg 73:37–43PubMedGoogle Scholar
  26. Mohty D, Dumesnil JG, Echahidi N, Mathieu P, Dagenais F, Voisine P, Pibarot P (2009) Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesity, and left ventricular dysfunction. J Am Coll Cardiol 53:39–47PubMedGoogle Scholar
  27. Moon MR, Lawton JS, Moazami N, Munfakh NA, Pasque MK, Damiano RJ Jr (2009) POINT: prosthesis-patient mismatch does not affect survival for patients greater than 70 years of age undergoing bioprosthetic aortic valve replacement. J Thorac Cardiovasc Surg 137:278–283PubMedGoogle Scholar
  28. Oosterlinck W, Meuris B, Herregods MC, Vandeplas A, Daenen W, Flameng W, Herijgers P (2009) Long-term results with a stentless porcine aortic valve: the Edwards PRIMA model 2500. J Heart Valve Dis 18:198–206PubMedGoogle Scholar
  29. Pibarot P, Dumesnil JG (2000) Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol 36:1131–1141PubMedGoogle Scholar
  30. Rahimtoola SH (1978) The problem of valve prosthesis-patient mismatch. Circulation 58:20–24PubMedGoogle Scholar
  31. Rao V, Jamieson WR, Ivanov J, Armstrong S, David TE (2000) Prosthesis-patient mismatch affects survival after aortic valve replacement. Circulation 102:III5–III9PubMedGoogle Scholar
  32. Richards KL (1991) Assessment of aortic and pulmonic stenosis by echocardiography. Circulation 84:I182–I187PubMedGoogle Scholar
  33. Roscitano A, Benedetto U, Sciangula A, Merico E, Barberi F, Bianchini R et al (2006) Indexed effective orifice area after mechanical aortic valve replacement does not affect left ventricular mass regression in elderly. Eur J Cardiothorac Surg 29:139–143PubMedGoogle Scholar
  34. Ryomoto M, Mitsuno M, Yamamura M, Tanaka H, Kobayashi Y, Fukui S et al (2008) Patient-prosthesis mismatch after aortic valve replacement in the elderly. Gen Thorac Cardiovasc Surg 56:330–334PubMedGoogle Scholar
  35. Sauerbrei W, Royston P, Binder H (2007) Selection of important variables and determination of functional form for continuous predictors in multivariable model building. Stat Med 26:5512–5528PubMedGoogle Scholar
  36. Sommers KE, David TE (1997) Aortic valve replacement with patch enlargement of the aortic annulus. Ann Thorac Surg 63:1608–1612PubMedGoogle Scholar
  37. Tasca G, Brunelli F, Cirillo M, Amaducci A, Mhagna Z, Troise G, Quaini E (2003) Mass regression in aortic stenosis after valve replacement with small size pericardial bioprosthesis. Ann Thorac Surg 76:1107–1113PubMedGoogle Scholar
  38. Tasca G, Brunelli F, Cirillo M, DallaTomba M, Mhagna Z, Troise G, Quaini E (2005) Impact of valve prosthesis-patient mismatch on left ventricular mass regression following aortic valve replacement. Ann Thorac Surg 79:505–510PubMedGoogle Scholar
  39. Tasca G, Mhagna Z, Perotti S, Berra Centurini P, Sabatini T, Amaducci A et al (2006) Impact of prosthesis-patient mismatch on cardiac events and midterm mortality after aortic valve replacement in patients with pure aortic stenosis. Circulation 113:570–576PubMedGoogle Scholar
  40. Tsutsumi K, Nagumo M, Nishikawa K, Takahashi R (2008) Effect of prosthesis-patient mismatch on survival after aortic valve replacement using mechanical prostheses in patients with aortic stenosis. Gen Thorac Cardiovasc Surg 56:577–583PubMedGoogle Scholar
  41. Urso S, Sadaba R, Vives M, Trujillo J, Beltrame S, Soriano B, Piqueras L, Aldamiz-Echevarria G (2009) Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survival. J Heart Valve Dis 18:248–255PubMedGoogle Scholar
  42. Vanky FB, Hakanson E, Tamas E, Svedjeholm R (2006) Risk factors for postoperative heart failure in patients operated on for aortic stenosis. Ann Thorac Surg 81:1297–1304PubMedGoogle Scholar
  43. Wagner IM, Eichinger WB, Bleiziffer S, Botzenhardt F, Gebauer I, Guenzinger R et al (2007) Influence of completely supra-annular placement of bioprostheses on exercise hemodynamics in patients with a small aortic annulus. J Thorac Cardiovasc Surg 133:1234–1241PubMedGoogle Scholar
  44. Walther T, Rastan A, Falk V, Lehmann S, Garbade J, Funkat AK et al (2006) Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement. Eur J Cardiothorac Surg 30:15–19PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2020

Authors and Affiliations

  1. 1.Klinik für Thorax- und KardiovaskularchirurgieBad OeynhausenDeutschland

Personalised recommendations