Effect of Prosthesis-Patient Mismatch on Long-Term Survival With Aortic Valve Replacement: Assessment to 15 Years

Jamieson, W.R. Eric; Ye, Jian; Higgins, Jennifer; Cheung, Anson; Fradet, Guy; Skarsgard, Peter; Eva, Gudumac; Chan, Florence; Lichtenstein, Samuel V.

doi:10.1016/j.athoracsur.2009.08.070

Cited by 99 publications

(72 citation statements)

References 23 publications

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“…Thus, several recent studies confirm that PPM is independently associated with reduced late survival [33-38••], whereas others report the opposite [39][40][41]. In this context, it is becoming increasingly clear that the analysis of patients' characteristics is of paramount importance when interpreting such data and in this sense the findings of a recent study from our laboratory [38••] may provide some insight into the discrepancies observed in previous studies.…”

Section: Late Mortalitymentioning

confidence: 68%

Prosthesis-Patient Mismatch: An Update

Dumesnil

Pîbarot

2011

Curr Cardiol Rep

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Prosthesis-patient mismatch (PPM) is present when the effective orifice area of the inserted prosthetic valve is too small in relation to body size. Its main hemodynamic consequence is to generate higher than expected gradients through normally functioning prosthetic valves. The purpose of this review is to present an update on the present state of knowledge with regard to diagnosis, prognosis, and prevention of PPM. PPM is a frequent occurrence (20% to 70% of aortic valve replacements) that has been shown to be associated with worse hemodynamics, less regression of left ventricular hypertrophy, more cardiac events, and lower survival. Moreover, as opposed to most other risk factors, PPM can largely be prevented by using a prospective strategy at the time of operation.

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Section: Late Mortalitymentioning

confidence: 68%

Prosthesis-Patient Mismatch: An Update

Dumesnil

Pîbarot

2011

Curr Cardiol Rep

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“…13,14,23 In addition, we found a prevalence of severe PPM (indexed EOA ≤0.65 cm 2 /m 2 ) of 7%, which is also similar to that in literature. 24,25 In line with other articles, our patients with PPM are older with a history of multiple comorbidities. The impact of PPM on long-term survival reported in the present study confirms the results of a previous large study focusing specifically on patients operated for aortic stenosis 14 ; it is also in accordance with the results of 2 large meta-analysis 26,27 reporting that PPM is independently associated with overall survival after pooling a large number of studies using the in vivo indexed EOA.…”

Section: September 9 2014mentioning

confidence: 51%

“…However, the EOA expressed as a continuous variable was associated with poorer long-term survival in multivariable analyses, which is consistent with previous studies. 15,24,25,28 …”

Section: Limitationsmentioning

confidence: 99%

Prevalence and Long-Term Outcome of Aortic Prosthesis–Patient Mismatch in Patients With Paradoxical Low-Flow Severe Aortic Stenosis

et al. 2014

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Background— Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis–patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS. Methods and Results— Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm 2 ). A PLF (indexed stroke volume ≤35 mL/m 2 ) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area ≤0.85 cm 2 /m 2 . The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P <0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P =0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5–4.45; P =0.0007). Conclusions— In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome.

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“…11,16,17 Although these studies differ in several ways, including use of more recent models of biological and mechanical valves, some important trends emerge. A recent series by Weber et al 17 A report from Brown et al 11 examined the late results of AVR (including those undergoing concomitant coronary artery bypass grafting) using either St Jude bileaflet valves (St Jude Medical Inc, Minneapolis, MN) or a CarpentierEdwards bioprosthetic valve (model numbers 2625, 2700, and 2800; Edwards lifesciences llC, Irvine, CA) in patients aged between 50 and 70 years.…”

Section: Observational Studiesmentioning

confidence: 99%

“…It is important to note that these findings in individuals aged 50 to 70 years contrast with our experience in elderly (≥70 years) patients where survival after AVR was related to comorbidities and not to valve type alone. 19 Additional information regarding the influence of valve type on survival comes from Jamieson et al, 16 who reviewed 3343 patients undergoing AVR to determine the impact of patient-prosthesis mismatch. Although mismatch did not influence late survival, independent predictors of overall mortality included older age, New York Heart Association (NYHA) III/ IV functional class, and use of a biological device in the aortic position (relative risk, 1.2; P=0.018).…”

Section: Observational Studiesmentioning

confidence: 99%