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

Jamieson, W.R. Eric; Eva, Gudumac; Ye, Jian; Chan, Florence; Cheung, Anson; MacNab, Joan S.; Fradet, Guy; Stanford, Elizabeth A.; Bryson, Lucinda A.; Lichtenstein, Samuel V.

doi:10.1016/j.athoracsur.2009.01.056

Cited by 39 publications

(48 citation statements)

References 19 publications

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“…[22][23][24] Within the last 10 years, several important articles about PPM after MVR have been published, in which the authors describe PPM after MVR and longterm clinical outcome. [15][16][17][18][19][20][21] The key message of this study was 1) the incidence of PPM after MVR is higher when r-EOAI instead of m-EOAI is used in defining PPM. 2) PPM after MVR was not associated with the MACE, pulmonary hypertension, and survival.…”

Section: Discussionmentioning

confidence: 95%

“…They used the referred EOAI to define the PPM. 20) However, they did not consider preoperative and postoperative variables, such as diabetes mellitus, renal failure, chronic obstructive pulmonary disease, and valve pathologies. We had a few similar limitations in our outcome analysis, namely, we inferred the pulmonary arterial pressure using the trans-tricuspid pressure gradient (an index for systemic pulmonary artery pressure).…”

Section: Discussionmentioning

confidence: 99%

“…Within the past 10 years, there has been greater interest in PPM after MVR. [15][16][17][18][19][20][21] For determining PPM, some investigators measured the actual effective orifice area index (EOAI), though others referred to reported EOAI values. 15,16,19) The objectives of this study were to determine the impact of PPM after MVR on late clinical outcome determined from the echocardiograph, utilizing measured EOAI (m-EOAI) or referred EOAI (r-EOAI) and to correlate m-EOAI and r-EOAI.…”

Section: Introductionmentioning

confidence: 99%

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Prosthesis-patient Mismatch after Mitral Valve Replacement Stratified by Referred and Measured Effective Valve Area

Matsuura

Mogi

Aoki

et al. 2011

ATCS

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Objective: The aim of this study was to determine the impact of patient-prosthesis mismatch (PPM) after mitral valve replacement (MVR) on the late clinical outcome, evaluated from the referred value and measured mitral valve area in the echocardiograph. Patients and Method: The records of 212 patients who underwent MVR between 1995 and 2008 at Funabashi Municipal Medical Center, Japan were studied retrospectively. Exclusions were patients who had a repeat MVR or concomitant aortic valve surgery. Of 212 patients, 163 underwent the Doppler echocardiographic study more than 1 year after surgery. Primary endpoint was late survival, and secondary endpoint was major adverse cardiac event (MACE). The average follow-up period was 53.1 ± 100.8 months. The effective orifice area index (EOAI) was calculated using the referred effective orifice area (r-EOA) and measured effective orifice area (m-EOA). An EOAI smaller than 1.2 cm 2 /m 2 defined PPM. Results: For r-EOAI, 125 patients (group P) had PPM and 87patients (group N) did not. Between groups, there was a significant difference in the proportion of males (group P vs. N; 59% vs. 23%; P = 0.0001), postoperative NYHA class (1.02 ± 6.2 vs. 9.8 ± 1.6, P = 0.04), late mitral valve area (MVA) (2.50 ± 0.56 vs. 2.78 ± 0.60, P = 0.005), and peak transmitral pressure gradient (MPG) 11.9 ± 6.2 vs 9.8 ± 1.6, P = 0.04). However, there was no difference in late survival (P = 0.55) or incidence of a major cardiac adverse event (MACE) (P = 0.14). For m-EOAI, 17 patients (group P) had PPM and 146 patients (group N) did not. Between groups, there was a difference in the bioprosthetic valve (group P vs. N; 76% vs. 26%, P = 0.006) and mean MPG (5.2 ± 2.3 vs. 3.7 ± 1.8, P = 0.02). However, there was no difference in late survival (P = 0.99) and incidence of MACE (P = 0.86). The r-and m-EOAI were well correlated (correlation coefficient 0.46; 0.33-0.5) Conclusions: The PPM after MVR was not related to the late survival or the incidence of MACE based on both r-and m-EOAI. The patient group of PPM defined by r-EOAI tended to be male and that defined by m-EOAI tended to be bioprosthetic.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prosthesis-patient Mismatch after Mitral Valve Replacement Stratified by Referred and Measured Effective Valve Area

Matsuura

Mogi

Aoki

et al. 2011

ATCS

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“…Overall operative mortality was 9.6% (13/136 patients) and isolated non-urgent MVR mortality was 6.3% (6/95 patients), while mortality after combined or urgent MVR was 15 (Fig. 2).…”

Section: Resultsmentioning

confidence: 98%

“…On the contrary, other studies did not detect a deleterious impact of PPM on long-term survival after MVR [11][12][13]15]; however, there is apparently an interaction between preoperative PH and long-term outcome in patients with both moderate and severe PPM [2,3]. In our series, not only patients with severe mitral PPM associated or not to preoperative PH but also those presenting moderate mismatch with preoperative systolic pulmonary pressure > 55 mm Hg showed lower long-term survival.…”

Section: Discussionmentioning

confidence: 99%

Incidence of prosthesis-patient mismatch in patients receiving mitral Biocor® porcine prosthetic valves

Borracci¹,

Rubio²,

M³

et al. 2016

Cardiol J.

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Predictors of persistent pulmonary hypertension after mitral valve replacement

et al. 2015

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Persistent pulmonary hypertension (P-PH) after mitral valve replacement (MVR) leads to an increased risk of morbidity and mortality. We sought to determine which factors were involved in its occurrence. Patients undergoing MVR for a 3-year period were collected in a retrospective way. We excluded those with an available follow-up shorter than 3 months. Sample size was 111 patients. PH was diagnosed if systolic pulmonary artery pressure (sPAP) estimated by Doppler echocardiography was >40 mmHg. Clinical, echocardiographic, and surgical factors were analyzed. P-PH was present in 42.3 % of patients after 12.6 months of mean follow-up. P-PH was more frequently observed in elderly and female patients, in those with severe degrees of PH before surgery, and significant tricuspid regurgitation (TR). On multivariable analysis, significant TR (OR 1.739; p = 0.01) and more severe degrees of PH before surgery (OR 1.761; p = 0.03) were significantly associated with the presence of P-PH after MVR. Surgical factors related to P-PH were prosthesis size and tricuspid annuloplasty: no need for the performing of tricuspid annuloplasty (OR 0.345; p = 0.025) and the implantation of a smaller prosthesis (OR 0.656; p = 0.004) were related to higher rates of P-PH after MVR. MVR was associated with high prevalence of P-PH after mid-term follow-up. Both PH and significant TR before surgery were associated with P-PH. Our data point out that MVR should be planned before the development of PH and greater TR. Smaller prosthetic size is also a risk factor for P-PH and bigger prostheses are desirable when possible.

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

Cited by 39 publications

References 19 publications

Prosthesis-patient Mismatch after Mitral Valve Replacement Stratified by Referred and Measured Effective Valve Area

Prosthesis-patient Mismatch after Mitral Valve Replacement Stratified by Referred and Measured Effective Valve Area

Incidence of prosthesis-patient mismatch in patients receiving mitral Biocor® porcine prosthetic valves

Predictors of persistent pulmonary hypertension after mitral valve replacement

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