Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve Replacement

Dayan, Víctor; Vignolo, Gustavo; Soca, Gerardo; Paganini, Juan José; Brusich, Daniel; Pîbarot, Philippe

doi:10.1016/j.jcmg.2015.10.026

Cited by 180 publications

(160 citation statements)

References 45 publications

Supporting

Mentioning

140

Contrasting

Unclassified

Order By: Relevance

“…In a recent meta-analysis by Dayan and colleagues of 58 reports, they identified that up to a moderate degree of PPM was associated with one and a half times increased risk of early mortality, and in patients with severe PPM, mortality was increased two and a half times 14. The trend towards lower survival was noted to continue during follow-up, with late mortality being higher in those with severe PPM.…”

Section: Clinical Outcomesmentioning

confidence: 98%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

View full text Add to dashboard Cite

Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.

show abstract

Section: Clinical Outcomesmentioning

confidence: 98%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

View full text Add to dashboard Cite

show abstract

“…4,5 A previous study showed that the effect of PPM on mortality was greater in patients <70 years of age, and predictors of PPM were older age, large BSA, and an implanted bioprosthesis. 6 It has been suggested that PPM has a significant effect on short-term and long-term outcomes. [7][8][9] Because the NOTION trial showed that the incidence of PPM was lower after TAVR than after surgical AVR at the mid-term follow-up, the hemodynamic performance of TAVR is not inferior compared with surgical AVR.…”

Section: Patients' Characteristicsmentioning

confidence: 99%

Reducing Prosthesis-Patient Mismatch With Edwards Magna Prosthesis for Aortic Valve Replacement

Kume

Fujita

Fukushima

et al. 2017

Circ J

View full text Add to dashboard Cite

Background: Prosthesis-patient mismatch (PPM) is associated with increased mid-term and long-term mortality rates after aortic valve replacement (AVR). This study aimed to evaluate the efficacy of the Carpentier-Edwards Perimount Magna and Magna Ease (CEPMs) aortic bioprostheses to reduce the incidence of PPM. Methods and Results:Altogether, 282 consecutive patients (113 women, mean age 69.9±9.9 years) underwent AVR with a CEPMs between 2008 and 2015. They were divided into 3 groups based on the risk of PPM as a result of their body surface area and aortic annular diameter (BSA/AnnD ratio): low-risk (LR) group: 0.64±0.05 m 2 /cm (n=94); medium-risk (MR) group: 0.73±0.02 m 2 /cm (n=94); high-risk (HR) group: 0.83±0.05 m 2 /cm (n=94). The 30-day mortality rate was 0.4%. The 5-year actuarial survival rates were 93.2%, 92.3%, and 94.8% for groups LR, MR, and HR, respectively. No explants as a result of structural valve deterioration occurred. No patients showed severe PPM, defined as a measured effective orifice area index (EOAI) <0.65 cm 2 /m 2 . Although there were significant (P<0.05) differences in EOAI (0.98±0.2, 0.90±0.21, and 0.88±0.1 cm 2 /m 2 among the LR, MR, and HR groups, respectively), the corresponding transvalvular mean pressure gradients (13.0±5.5, 12.3±4.0, 12.7±5.3 mmHg) and regression rates of the left ventricular mass (29.8%, 28.7%, 28.9%) were similar among groups. Conclusions:CEPMs provide low surgical risk and reduce the risks of PPM, even in HR patients, with excellent hemodynamics.

show abstract

“…It is important to note that improperly sized valves with PPM can hasten the development of early degenerative changes and premature PVD with varying degrees of prosthetic valve stenosis and regurgitation. [10] Therefore, it is crucial for clinicians to integrate the information derived from previous records, including annular size and valve size, with echocardiographic findings and patient parameters such as BSA at the time of redo cardiac surgery to prevent recurrence of similar problems in the future. Our patient presented with a higher BSA compared to that at his previous surgery, the AV annulus was small and the previously implanted 21 mm AV bioprosthesis manifested the stigmata of degenerative valve disease.…”

Section: Case Discussionmentioning

confidence: 99%

“…[10] The most susceptible patients include the ones with coronary artery disease requiring revascularization, depressed LV systolic function, severe LV hypertrophy, significant diastolic dysfunction, concomitant MR, and paradoxical low-flow low-gradient aortic stenosis (PLF-LG AS). [29303132] It is also known that patients with a bioprosthesis have a three-time higher risk of developing PPM compared to those with mechanical AVs.…”

Section: Risk Factors For Development Of Ppmmentioning

confidence: 99%

See 1 more Smart Citation

Prosthesis-patient mismatch - what cardiac anesthesiologists need to know?

Subramaniam¹,

Nazarnia²

2017

Ann Card Anaesth

View full text Add to dashboard Cite

Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.

show abstract

Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve Replacement

Cited by 180 publications

References 45 publications

Patient-prosthesis mismatch following aortic valve replacement

Patient-prosthesis mismatch following aortic valve replacement

Reducing Prosthesis-Patient Mismatch With Edwards Magna Prosthesis for Aortic Valve Replacement

Prosthesis-patient mismatch - what cardiac anesthesiologists need to know?

Contact Info

Product

Resources

About