Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant

Hanayama, Naoji; Christakis, George T.; Mallidi, Hari R.; Joyner, Campbell; Fremes, Stephen E.; Morgan, Christopher D.; Mitoff, Peter R.; Goldman, Bernard S.

doi:10.1016/s0003-4975(02)03582-8

Cited by 158 publications

(131 citation statements)

References 13 publications

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“…8,9,12 This finding may be related to the fact that patients' LV function and hemodynamic status are more vulnerable during the early postoperative period and that an increase in afterload due to PPM may contribute to the development of irreversible LV failure, especially in patients already having depressed LV function before operation. 9 In the present study the number of perioperative deaths was, however, too small to allow meaningful analysis of the impact of PPM on in-hospital mortality.…”

Section: Impact Of Ppm On Survivalmentioning

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

199

139

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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: Impact Of Ppm On Survivalmentioning

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

199

139

View full text Add to dashboard Cite

show abstract

“…However, short-term mortality was not analyzed nor was left ventricular function taken into account. Nonetheless, when considered collectively, these previous studies 6,7,10,11 might indirectly suggest that the greatest impact of PPM with regards to survival is in the early postoperative period when the left ventricle is most vulnerable. Our results also suggest that there could be a natural selection process at that time of operation during which many patients at risk do not survive beyond the early postoperative period, which in turn could explain the relatively better prognosis of moderate-severe PPM beyond that critical period.…”

Section: Mismatch As a Predictor Of Short-term Mortalitymentioning

confidence: 94%

Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement

et al. 2003

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Background-The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. This study examined if there is a relation between PPM and short-term mortality after operation. ; it was correlated with 30-day mortality and compared with other relevant variables. Moderate or severe PPM was present in 38% of patients. Thirty-day mortality was 4.6% (58/1266 patients) and the strongest independent predictors in multivariate analysis were left ventricular ejection fraction Ͻ40% (Pϭ0.007), infectious endocarditis (Pϭ0.002), emergent/salvage operation (Pϭ0.002), cardiopulmonary bypass time Ͼ120 minutes (Pϭ0.001), and PPM (Pϭ0.003). Relative risk of mortality was increased 2.1-fold (95% confidence interval, 1.2 to 3.7) in patients with moderate PPM and 11.4-fold (4.4 to 29.5) in those with severe PPM. Moreover, risk of mortality for every category of PPM was higher in patients with a left ventricular ejection fraction Ͻ40% as compared with Ն40% (nonsignificant PPM, 2.7 versus 1.0; moderate PPM, 7.1 versus 1.8; severe PPM, 77.1 versus 11.3). Conclusion-PPM is a strong and independent predictor of short-term mortality among patients undergoing AVR, and its impact is related both to its degree of severity and the status of left ventricular function. In contrast to other risk factors, moderate-severe PPM can be largely avoided with the use of a prospective strategy at the time of operation.

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“…24 A number of investigators have reported on the association between left ventricular hypertrophy and adverse outcomes. 24 -29 There are, however, a number of investigations that report similar survival, 17,30,31 valve-related morbidity, 30 NYHA functional class, and left ventricular mass index 30 for those with and without prosthesis-patient size mismatch.…”

Section: Impact Of Prosthesis-patient Size On Quality Of Lifementioning

confidence: 99%

Impact of Prosthesis–Patient Size on Functional Recovery After Aortic Valve Replacement

et al. 2005

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Background-Prosthesis-patient size mismatch results when an implanted prosthetic aortic valve is of insufficient size for a patient's body surface area. The relation between prosthesis-patient size and functional capacity and adverse postoperative outcome is inconsistent. Our objectives were to examine the impact of valve replacement, continuous prosthesis-patient size, and other factors on functional recovery after aortic valve replacement (AVR) with the Duke Activity Status Index (DASI

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Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant

Cited by 158 publications

References 13 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

Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement

Impact of Prosthesis–Patient Size on Functional Recovery After Aortic Valve Replacement

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