Impact of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement

Tasca, Giordano; Brunelli, Federico; Cirillo, Marco; DallaTomba, Margherita; Mhagna, Zen; Troise, Giovanni; Quaini, Eugenio

doi:10.1016/j.athoracsur.2004.04.042

Cited by 161 publications

(142 citation statements)

References 35 publications

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“…The Doppler-echocardiographic measurements were performed as previously described. 24,25 Briefly, the dimensions of the left ventricle (LV) were assessed with 2-dimensionally guided M-mode tracings, with the measurements being made according to the recommendations of the American Society of Echocardiography. Left ventricular mass (LVM) was calculated with the corrected American Society of Echocardiography formula.…”

Section: Doppler-echocardiographic Datamentioning

confidence: 99%

Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic Stenosis

Tasca

Mhagna²,

Perotti³

et al. 2006

Circulation

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199

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Background-Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthesis being implanted is too small in relation to body size, thus causing abnormally high transvalvular pressure gradients. The objective of this study was to examine the midterm impact of PPM on overall mortality and cardiac events after aortic valve replacement in patients with pure aortic stenosis. Methods and Results-The indexed EOA (EOAi) was estimated for each type and size of prosthesis being implanted in 315 consecutive patients with pure aortic stenosis. PPM was defined as an EOAi Յ0.80 cm 2 /m 2 and was correlated with overall mortality and cardiac events. PPM was present in 47% of patients. The 5-year overall survival and cardiac event-free survival were 82Ϯ3% and 75Ϯ4%, respectively, in patients with PPM compared with 93Ϯ3% and 87Ϯ4% in patients with no PPM (PՅ0.01). In multivariate analysis, PPM was associated with a 4.2-fold (95% CI, 1.6 to 11.3) increase in the risk of overall mortality and 3.2-fold (95% CI, 1.5 to 6.8) increase in the risk of cardiac events. The other independent risk factors were history of heart failure, NHYA class III-IV, severe left ventricular hypertrophy, and absence of normal sinus rhythm before operation. Conclusions-PPM is an independent predictor of cardiac events and midterm mortality in patients with pure aortic stenosis undergoing aortic valve replacement. As opposed to other risk factors, PPM may be avoided or its severity may be reduced with the use of a preventive strategy at the time of operation. (Circulation. 2006;113:570-576.)

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Section: Doppler-echocardiographic Datamentioning

confidence: 99%

Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic Stenosis

Tasca

Mhagna²,

Perotti³

et al. 2006

Circulation

Self Cite

199

139

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“…Several studies have reported that aortic PPM is associated with less improvement in symptoms and functional class, 30 impaired exercise capacity, 31 less regression of LV hypertrophy, 32 less improvement in coronary flow reserve, 33 and more adverse cardiac events. 30,34 Moreover, PPM has a significant impact on both short-term 35,36 and long-term mortality.…”

Section: Clinical Impact Of Ppmmentioning

confidence: 99%

Prosthetic Heart Valves

2009

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“…3) Though many have reported a link between PPM after aortic valve replacement (AVR) and late left ventricular function, cardiac events or survival, some do not agree that the link exists. [4][5][6][7][8][9][10][11][12][13][14] On the other hand, the focus of attention on PPM is its occurring after AVR instead of mitral valve replacement (MVR). Within the past 10 years, there has been greater interest in PPM after MVR.…”

Section: Introductionmentioning

confidence: 99%

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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Impact of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement

Cited by 161 publications

References 35 publications

Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic Stenosis

Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic Stenosis

Prosthetic Heart Valves

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

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