Aortic valve prosthesis–patient mismatch and exercise capacity in adult patients with congenital heart disease

Slooten, Ymkje J. van; Melle, Joost P. van; Freling, Hendrik G.; Bouma, Berto J.; Dijk, Arie P.J. van; Jongbloed, Monique R.M.; Post, Martijn C.; Sieswerda, Gertjan T.; Veld, Anna Huis in 't; Ebels, Tjark; Voors, Adriaan A.; Pieper, Petronella G.

doi:10.1136/heartjnl-2015-308013

Cited by 11 publications

(9 citation statements)

References 30 publications

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“…However, diastolic characteristics (not taken into account in our study) are also of importance in the release of NT-proBNP, as recently described for a CHD population [ 22 ]. Although we previously found an association between PPM and exercise capacity in AVR patients [ 23 ], this did not translate into higher NT-proBNP levels in this subgroup. At least for AVR patients, a possible explanation could be the rather preserved left ventricular systolic function (mean LVEF 57 %).…”

Section: Discussioncontrasting

confidence: 61%

NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study

et al. 2016

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ObjectivesN-terminal B‑type natriuretic peptide (NT-proBNP) is an important biomarker for the detection of heart failure. Adults with congenital heart disease (ACHD) and a prosthetic heart valve are at risk for heart failure. This study aimed to determine the value of NT-proBNP in ACHD patients with a prosthetic valve and investigate its relationship with cardiac function and exercise capacity.MethodsIn this multi-centre cross-sectional observational study, data regarding medical history, echocardiography, exercise testing (VO2peak) and laboratory blood evaluation (including NT-proBNP) were collected in ACHD patients with a single prosthetic valve (either homografts, heterografts or mechanical valves).ResultsA total of 306 ACHD patients with pulmonary valve replacement (PVR, n = 139), aortic valve replacement (n = 141), mitral valve replacement (n = 21) or tricuspid valve replacement (n = 5) were investigated. The majority of patients (77 %) were in NYHA class I or II. Elevated NT-proBNP levels (cut-off ≥125 pg/ml) were found in 50 % of the patients, with the highest levels in patients with mitral valve replacements. In this study population, NT-proBNP levels were associated with gender (p = 0.029) and VO2max (p < 0.001). In PVR patients, NT-proBNP levels were associated with lower VO2peak, also after adjustment for age, gender and age at valve replacement in a multivariate model (p = 0.015).ConclusionsIn patients with ACHD and a prosthetic valve, elevated NT-proBNP levels are frequently observed despite preserved NYHA class. In PVR patients, a higher NT-proBNP level was associated with a lower VO2peak. These results may be of importance in the ongoing discussion about the timing of valve replacement in patients with CHD.

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Section: Discussioncontrasting

confidence: 61%

NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study

et al. 2016

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“…The most important finding of this work6 is that the prevalence of severe PPM in these patients is 23%. But for those who were under 18 years old when they received their last AVR is 48%, which is more than four times the prevalence of severe mismatch in patients undergoing AVR due to adult heart disease 5.…”

mentioning

confidence: 67%

“…In their Heart publication, Van Slooten and colleagues,6 circumventing all the aforementioned difficulties, study the prevalence and impact on exercise capacity of PPM. First, in vivo values of IEOA based on echocardiograms during follow-up after surgery are used to calculate PPM considering adequate cut-off points.…”

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confidence: 99%

Patient prosthesis mismatch in adult congenital heart disease

Hernández-Vaquero

2015

Heart

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“…24,27,28 The influence of PPM on left ventricular function, exercise capacity, and need for reoperation in the young patient population is well established, emphasizing the need to select a prosthetic valve with optimal effective orifice area at implant. 1,13,24,28,29 Moon and colleagues 28 reported a negative influence in survival with moderate PPM (0.75 cm 2 /m 2 ) in young adults. Furthermore, recent studies by Rosu and colleagues 11 and Johnston and colleagues 22 found that 10 mm Hg increase in postoperative peak gradient was associated with a >2-fold increase in 20-year risk for reoperation.…”

Section: Discussionmentioning

confidence: 98%

Selection of prosthetic aortic valve and root replacement in patients younger than age 30 years

Milewski

Habertheuer

Bavaria

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Long-term outcomes of prosthetic aortic valve/root replacement in patients aged 30 years or younger are not well understood. We report our single institutional experience in this young cohort.Methods: From 1998 to 2016, 99 patients (age range, 16-30 years) underwent aortic valve replacement (n ¼ 57), aortic valve replacement and supracoronary ascending aorta replacement (n ¼ 6), or aortic root replacement (n ¼ 36). A prospectively maintained aortic valve database was retrospectively reviewed to complete longitudinal functional and clinical data. Total follow-up was 493 patient years.

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Aortic valve prosthesis–patient mismatch and exercise capacity in adult patients with congenital heart disease

Abstract: In this study we report a high prevalence (42%) of PPM in ACHD with an aortic valve prosthesis and an independent association of PPM with diminished exercise capacity.

Cited by 11 publications

References 30 publications

NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study

NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study

Patient prosthesis mismatch in adult congenital heart disease

Selection of prosthetic aortic valve and root replacement in patients younger than age 30 years

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