Impact of prosthesis-patient mismatch on mitral regurgitation after aortic valve replacement

Unger, Philippe; Magné, Julien; Eynden, Frédéric Vanden; Plein, Danièle; Camp, Guy Van; Pasquet, Agnès; Cosyns, Bernard; Dedobbeleer, Chantal; Lancellotti, Patrizio

doi:10.1136/hrt.2010.200428

Cited by 26 publications

(17 citation statements)

References 24 publications

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“…In the present study, 28% (117/419) of the patients had no or minimal reduction in MRV (ie, Ͻ15 mL) after isolated AVR, and PPM was found to be the main independent determinant of the postoperative persistence of SMR. These findings corroborate and extend those of Unger and colleagues, 3 obtained in a smaller series of patients with mitral regurgitation of diverse aetiologies (ie, primary and secondary). In the latter study, the negative association between PPM and regression of mitral regurgitation following AVR was observed only in the subset of patients with organic mitral regurgitation but not in that with SMR.…”

Section: Angeloni Et Al Mitral Regurgitation In Aortic Valve Replacementsupporting

confidence: 82%

“…The increase in mitral valve leaflet coaptation length was also smaller in patients with PPM (ϩ0.8Ϯ2. 3 In the subset of 86 patients who underwent 6MWT distance, preoperative walked distance was 272Ϯ103 and 276.4Ϯ98 m in the PPM (nϭ35/86, 40.7%) and no-PPM (nϭ51/86, 59.3%) group, respectively (Pϭ0.83). These patients showed similar baseline characteristics (age, sex, comorbidities, and echo measurements) and similar rate of PPM (35/86, 40.7%) when compared with the general population of the study.…”

Section: Factors Associated With Less Postoperative Regression Of Smrmentioning

confidence: 99%

“…There are several studies on PPM 10 -14 and several others on the prevalence of SMR in AS and its outcome following AVR, 2,3,5-8 but only one examined the impact of PPM on the postoperative evolution of concomitant mitral regurgitation SMR, 3 and this study included a relatively small number (42) of patients. The main objective of this study was thus to examine the relationship between PPM and regression of SMR following AVR for AS.…”

Section: Clinical Perspective On P 42mentioning

confidence: 99%

“…The degree of SMR generally improves after isolated AVR but to a variable extent depending on the patient. 3 The fall in LV cavity pressure achieved by AVR translates into an immediate decrease in the transmitral systolic pressure gradient and thereby into a reduction in SMR. Of note, this is also corroborated by the drop in pulmonary artery systolic pressures found among patients without PPM.…”

Section: Angeloni Et Al Mitral Regurgitation In Aortic Valve Replacementmentioning

confidence: 99%

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Impact of Prosthesis-Patient Mismatch on the Regression of Secondary Mitral Regurgitation After Isolated Aortic Valve Replacement With a Bioprosthetic Valve in Patients With Severe Aortic Stenosis

Angeloni

Melina

Benedetto

et al. 2012

Circ: Cardiovascular Imaging

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Background-Secondary mitral regurgitation (SMR) is generally reduced after isolated aortic valve replacement (AVR), but there is important interindividual variability in the magnitude of this reduction. Prosthesis-patient mismatch (PPM) may hinder normalization of left ventricular geometry and pressure overload following AVR, therefore we aimed to investigate the relationship between PPM and regression of SMR following AVR for aortic valve stenosis. Methods and Results-A total of 419 patients with AS who underwent isolated AVR at 2 institutions and presenting moderate SMR (mitral regurgitant volume 30 to 45 mL/beat) not considered for surgical correction were included in this study. Clinical and echocardiographic follow-up were completed at a median follow-up time of 37 months. PPM was defined as an indexed effective orifice area Յ0.85 cm 2 /m 2 and was found in 170/419 patients (40.6%). There were no significant differences in baseline and operative characteristics between patients with or without PPM. Patients with PPM had less regression of SMR following AVR compared with those with no PPM (change in mitral regurgitant volume:Ϫ11Ϯ4 versus Ϫ17Ϯ5 mL, respectively; PϽ0.0001). Variables significantly associated with postoperative change in mitral regurgitant volume on univariable analysis were entered in a multivariable linear regression model, which showed indexed effective orifice area (PϽ0.0001) and left atrial diameter (Pϭ0.006) to be independently associated with mitral regurgitant volume improvement. Patients with PPM also had less postoperative improvement in 6-minute walking test distance (80Ϯ78 versus 42Ϯ41 m, PϽ0.0001). Conclusions-PPM is associated with lesser regression of SMR following AVR. This unfavorable effect was associated with worse functional capacity. These findings emphasize the importance of operative strategies aiming to prevent PPM in patients with aortic valve stenosis and concomitant SMR. (Circ Cardiovasc Imaging. 2012;5:36-42.)

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Section: Angeloni Et Al Mitral Regurgitation In Aortic Valve Replacementsupporting

confidence: 82%

Section: Factors Associated With Less Postoperative Regression Of Smrmentioning

confidence: 99%

Section: Clinical Perspective On P 42mentioning

confidence: 99%

Section: Angeloni Et Al Mitral Regurgitation In Aortic Valve Replacementmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Prosthesis-Patient Mismatch on the Regression of Secondary Mitral Regurgitation After Isolated Aortic Valve Replacement With a Bioprosthetic Valve in Patients With Severe Aortic Stenosis

Angeloni

Melina

Benedetto

et al. 2012

Circ: Cardiovascular Imaging

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“…Postoperative decrease of MR severity seems to be more pronounced when the MR is functional and in the absence of pulmonary hypertension, atrial enlargement, atrial fibrillation22 or aortic prosthesis–patient mismatch 24. Because of the determinant role of increased afterload, the mitral effective regurgitant orifice decreases less than does the regurgitant volume.…”

Section: Managementmentioning

confidence: 99%

Management of multiple valve disease

Unger

Rosenhek

Dedobbeleer

et al. 2010

Heart

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Multivalvular heart disease is not an uncommon situation, but the paucity of data for each specific situation does not allow the proposal of a standardised, evidence-based management strategy. This paper aims at reviewing the available evidence on the management of multivalvular disease, taking into account the interactions between different valve lesions, the diagnostic pitfalls and the strategies that should be considered in the presence of multiple valvular disease.

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Aortic Valve

Henein¹,

Sheppard²,

Pepper³

et al. 2011

Clinical Echocardiography

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Impact of prosthesis-patient mismatch on mitral regurgitation after aortic valve replacement

Abstract: The presence of PPM after AVR attenuates postoperative mitral regurgitation changes, mainly in patients with organic mitral regurgitation.

Cited by 26 publications

References 24 publications

Impact of Prosthesis-Patient Mismatch on the Regression of Secondary Mitral Regurgitation After Isolated Aortic Valve Replacement With a Bioprosthetic Valve in Patients With Severe Aortic Stenosis

Impact of Prosthesis-Patient Mismatch on the Regression of Secondary Mitral Regurgitation After Isolated Aortic Valve Replacement With a Bioprosthetic Valve in Patients With Severe Aortic Stenosis

Management of multiple valve disease

Aortic Valve

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