Hemodynamically significant prosthesis‐patient mismatch can be predicted and is associated with early prosthetic valve dysfunction in aortic bioprosthesis

Abstract

Objectives: To evaluate the accuracy of predicted prosthesis-patient mismatch (PPM) regarding actual PPM measured postoperatively. To assess the association between PPM and prosthetic valve dysfunction.Methods: Retrospective cohort study including adult patients after aortic valve replacement surgery with a biological prosthesis. Predicted PPM status was determined using mean reference effective orifice area indexed to total body surface (iEOA), without considering reference standard deviations. Postoperative PPM status was determined by measuring iEOA within the first 60 postoperative days. Prosthetic valve dysfunction was defined as thrombosis, pannus, valve degeneration, and/or disruption.Results: 205 patients were enrolled between January 2003 and June 2017: predicted PPM was absent in 52 patients (25.4%), moderate in 137 patients (66.8%), and severe in 16 patients (7.8%). After surgery, the actual postoperative iEOA was measured: 53 (25.9%) did not have PPM, 73 had moderate PPM (35.6%), and 79 had severe PPM (38.5%). Predicted PPM identified the presence of hemodynamically significant actual postoperative PPM (OR = 2.56; 95%CI 1.30-5.05; P = .006), though not its degree of severity. Prosthetic valve dysfunction was more frequent among patients with hemodynamically significant PPM (53.9% vs. 11.3%; P < .001), compared to those without PPM. The association between PPM and prosthetic valve dysfunction was maintained after adjusting for gender, age, and ever-smoking (OR = 9.03; P < .001). The incidence of thrombosis or pannus was also nonsignificantly higher in patients with moderate or severe PPM. Conclusions: Predicted PPM identifies the presence, possibly not the severity, of actual postoperative PPM. Moderate or severe PPM is associated with prosthetic valve dysfunction.| 815 RONDEROS Et al.

Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future

“…Nevertheless, several studies have demonstrated quite the contrary. 2,3,[8][9][10] Fallon et al 8 published a large national study using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database including 59,779 patients ≥65 years old who underwent isolated SAVR between 2004 and 2014, revealing that patients with any degree of PPM (including moderate) had higher mortality and higher rates of readmission for congestive heart failure and redo SAVR over time owing to SVD. Additionally, a large meta-analysis 2 including 70 articles with 108,182 patients who underwent SAVR found an incidence of PPM after SAVR of 53.7% and showed that perioperative mortality, 1, 5-, and 10-year mortality, were increased in patients with PPM regardless of severity.…”

“…The impact of PPM on clinical outcomes after SAVR/TAVR is not accepted universally because several studies 4–7 failed to show PPM as a risk factor for mortality and SVD. Nevertheless, several studies have demonstrated quite the contrary 2,3,8–10 …”