Influence of Patient-Prosthesis Mismatch in the Octogenarian Undergoing Surgery for Aortic Valve Replacement Due to Severe Stenosis

Hernández-Vaquero, Daniel; Calvo, David; García, Jorge Alberto Osuna; Lozano, Íñigo; Morales, Carlos; Naya, J.L.; Morı́s, César; Llosa, Juan C.

doi:10.1016/j.rec.2011.05.012

Cited by 9 publications

(11 citation statements)

References 30 publications

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“…26 The percentage of PPM in this study (43%) was not larger than in previous American and European elderly studies, which varied between 60% and 63%. 24-26 Therefore, PPM is not the inherent problem, particularly in Japanese octogenarians.…”

Section: Racial Differences Between Japanese and Other Developed Councontrasting

confidence: 63%

Impact of Ejection Fraction on Long-Term Outcome After Elective Aortic Valve Replacement in Octogenarians With Aortic Stenosis

Shibayama

Watanabe

Tabata

et al. 2012

Circ J

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Background: Aortic stenosis (AS) is increasingly common in the elderly population. A recent invention of transcatheter aortic valve implantation tends to tilt the risk-benefit balance to favor earlier elective intervention for AS. Hence, decision making for elective intervention in octogenarians gradually becomes important. However, the outcome after elective aortic valve replacement (eAVR) has not been evaluated adequately. This study aimed to identify risk factors after eAVR in octogenarians and investigate their influence on long-term outcome. Methods and Results:One hundred and thirty-seven consecutive Japanese octogenarians with AS who underwent eAVR were studied. The mean follow-up period was 35±22 (range, 0-88) months. Long-term overall survival rates after eAVR were 92.0%, 85.2% and 75.5% at 1, 3 and 5 years, respectively. Cox proportional hazards model identified age [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.07-1.43; P<0.01)] and ejection fraction (EF) <50% (HR 3.38; 95%CI 1.34-8.52; P<0.01) as the risk factors of mortality. Post-eAVR survival rates in octogenarians with an EF ≥50% and <50% were 97.3% and 70.4% at 1 year, 90.1% and 65.3% at 3 years, and 84.3% and 39.2% at 5 years, respectively (P<0.0001). Conclusions:Octogenarians with preserved LV systolic function before surgery have favorable long-term survival after eAVR. However, an EF <50% influences the mortality in octogenarian patients. Therefore, eAVR should be considered for octogenarians with AS before the progression of LV impairment. Methods Study PopulationA retrospective study was conducted with 137 consecutive Japanese octogenarians who underwent eAVR for AS between July 2004 and October 2010 at the Department of Cardiovascular Surgery of the Sakakibara Heart Institute, Tokyo, Japan. Preoperative demographic and perioperative data were retrieved from our computerized database. The primary end point was survival, which was obtained by reviewing inpatient records and follow-up records at outpatient clinics attended by discharged patients, and telephone interviews for a longer term outcome of 1 year or longer after surgery. This study was approved by the human ethics committee of the Sakakibara Heart Institute. Informed consent regarding participation in any clinical research was obtained from all subjects through the Sakakibara Heart Integrative Profile when patients were admitted to our hospital, and their data was available for this study. EchocardiographyComprehensive 2D and Doppler transthoracic echocardiography was performed at the Sakakibara Heart Institute in all patients within 2 months before and 1 week after AVR. A midterm follow-up echocardiography was performed at random from 3 months to 1 year after hospital discharge. A long-term follow-up echocardiography was performed routinely at 1 year after and beyond.Peak transaortic velocity (Vp) and mean transaortic pressure gradient (MPG) were measured by continuous wave Doppler using a multiwindow approach. The aortic valve area (AVA) and actual effective orifice are...

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Section: Racial Differences Between Japanese and Other Developed Councontrasting

confidence: 63%

Impact of Ejection Fraction on Long-Term Outcome After Elective Aortic Valve Replacement in Octogenarians With Aortic Stenosis

Shibayama

Watanabe

Tabata

et al. 2012

Circ J

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“…Moreover, the impact that PPM can have on exercise tolerance and quality of life seems to be significantly influenced by the age of the sample analyzed. So, whereas studies focused on septuagenarian or octogenarian patients [18][19][20] show no evidence of an association between PPM and quality of life, those focused on general population 21,22 do reveal this association. The results obtained in our study are consistent with the current trend in the literature and support the hypothesis previously proposed about the vulnerability of the younger population in the presence of a PPM.…”

Section: Influence Of Ppm On Cardiac Event-free Survival and Quality mentioning

confidence: 88%

Moderate Patient-Prosthesis Mismatch Predicts Cardiac Events and Advanced Functional Class in Young and Middle-Aged Patients Undergoing Surgery Due to Severe Aortic Stenosis

et al. 2013

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“…Alternatively, while some researchers have defended the hypothesis that PPM affect survival and/or functional class [15,16], others consider it a phenomenon with no clinical importance or that only affects the prognosis in young patients and in patients of any age with ventricular dysfunction [17,18].…”

Section: Discussionmentioning

confidence: 99%

Valve prosthesis-patient mismatch: hemodynamic, echocardiographic and clinical consequences

Pisano¹,

D'Amico²,

Palmeri³

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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Aortic valve replacement with 17 mm SJMR or 19 mm SJMR prostheses appear to provide satisfactory clinical and hemodynamic results at rest and under DSE, even in those patients with BSA of 1.8 ± 0.11 m(2) where it was not possible to enlarge the aortic annulus. Prosthesis-patient mismatch is not associated with lesser regression of left ventricular mass. Dobutamine stress echocardiography should be a useful and effective means for evaluating prosthesis hemodynamic aspects.

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Influence of Patient-Prosthesis Mismatch in the Octogenarian Undergoing Surgery for Aortic Valve Replacement Due to Severe Stenosis

Cited by 9 publications

References 30 publications

Impact of Ejection Fraction on Long-Term Outcome After Elective Aortic Valve Replacement in Octogenarians With Aortic Stenosis

Impact of Ejection Fraction on Long-Term Outcome After Elective Aortic Valve Replacement in Octogenarians With Aortic Stenosis

Moderate Patient-Prosthesis Mismatch Predicts Cardiac Events and Advanced Functional Class in Young and Middle-Aged Patients Undergoing Surgery Due to Severe Aortic Stenosis

Valve prosthesis-patient mismatch: hemodynamic, echocardiographic and clinical consequences

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