Abstract:Since 1978 the definition of prosthesis-patient mismatch（PPM） was first introduced by Rahimtoola, it has attracted the attention of foreign researchers. The PPM phenomenon is concerned to be an important factor which will affect patients＇ survival rate and quality of life. Till now, a lot of effort should still be put on this problem. But unfortunately, this problem is still being neglected in our country. This paper is a review of PPM from it＇s many aspects, such as definition, current research status, prevention, and it＇s research prospect. We hope this paper will intensify the clinicians＇ knowledge on PPM.
Objective To investigate the further results of thoracoabdominal aortic aneurysm (TAAA) repair， and analyze the midterm results of 63 cases treated by total thoraco abdominal aortic replacement with a tetrafurcate graft. Methods From August 2003 to October 2007，total thoracoabdominal aortic replacement with a tetrafurcate graft was performed in 63 consecutive patients with Crawford Ⅱ TAAA in Fu Wai Hospital. There were 46 male and 17 female with a mean age of 39.98 years (17-71 years). All the procedures were performed through combined thoracoabdominal incision via the retroperitoneal approach and underwent profound hypothermia with shorttime interval circulatory arrest. T6 to T12 intercostal arteries were reconstructed by arterial tube technique. The celiac artery， superior mesenteric artery and right renal artery were joined into a patch and anastomosed to the end of the main graft. Left renal artery was anastomosed to an 8 mm branch or joined to the visceral arterial patch. The other 10 mm branches were anastomosed to iliac arteries. KaplanMeier method was used to perform survival analysis. Results All the cases were followed，and the mean followup time was 36.57(8-57) months. No patient died during the operation. Early mortality rate was 7.94%（5/63）. Among them， 4 patients died of multiple organ failure. Two of them were caused by neurological complications, and the other 2 of them were caused by renal failure. One patient died of low cardiac output syndrome after surgery because of coronary artery disease. This patient underwent coronary artery bypass grafting (CABG) emergently, but couldn’t wean from cardiopulmonary bypass. The incidence of stroke and temporary neurological dysfunction was 9.52%（6/63）, 4 of them were temporary neurological dysfunction and were cured before discharged from hospital. Paraplegia and paraparesis occurred in 2 and 1, respectively. They were all [CM(158.3mm]cured before leaving hospital. Pulmonary complication was 25.40%(16/63)， and12 of them were cured. Pseudoaneurysmal change was observed in reconstructed intercostal arteries in 2 patients with Marfan syndrome, but neither of them underwent paraplegia or paraparesis. One patient died at 20th, 23rd, 30th month after discharge, respectively. The survival time of this group was 50.64±2.13 months（95%CI：46.47,54.84 months） with a survival rate of 92.06% after 1 year， 88.38% after 2 years， 86.11% after 3 years. Conclusion Using tetrafurcate graft is a reliable method in total thoracoabdominal aortic replacement and has a satisfactory midterm survival rate. The intercostal arteries reconstruction by arterial tube technique in total thoracoabdominal replacement is simple, and it is helpful in spinal cord protection.
Abstract: Objective To investigate the in vivo effective orifice area (EOA) and whether prosthesispatient mismatch (PPM) is going to happen after 19mm St.Jude Regent valves replacement were performed. Methods Twentythree patients with valvular heart diseases were divided into 2 groups according to aortic annular diameter. 19mm St. Jude Regent valves were replaced in aortic valve place (Regent valve group), and 21mm other doubleleaflet mechanical valves were replaced in aortic place (other valves group). All of the operations were accomplished under cardiopulmonary bypass in West China Hospital. All of the patients were followed up in 3 to 6 months after their surgery processes. Color Doppler echocardiography was used to measure the hemodynamic parameters in their followup. Then left ventricular mass (LV mass), EOA and effective orifice area index (EOAI) etc. were calculated and compared by using SPSS 12.0. Results No cardiac episodes were detected during the perioperative period and 36 months after operation. LVmass reduced in 36 months after operation in both groups. No statistical significance of EOA, EOAI and LVmass reduction were detected between the two groups. Conclusions (1)The EOA and in vivo hemodynamic effects of 19mm Regent valve are similar to 21mm other double leaflet mechanical valve. (2)It is safe to use 19mm Regent valve in those patients whose aortic annular diameter are small and need double valve replacement. Using 19mm Regent valve will not cause short time cardiac episodes and PPM. (3)More further works should be done to make sure what is the standard of PPM in Chinese people, such as enlarging the patients number and prolonging the followup time. (4) Further clinical and followup works should be done to make St.Jude Regent valve’s feature out.