Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement: Neither Uncommon nor Harmless

Rayol, Sérgio da Costa; Cavalcanti, Luiz Rafael Pereira; Saragiotto, Felipe Augusto Santos; Diniz, Roberto; Sá, Frederico Browne Correia de Araújo e; Menezes, Alexandre; Silva, Frederico Pires Vasconcelos; Lima, Ricardo Carvalho

doi:10.21470/1678-9741-2019-0008

Cited by 10 publications

(8 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1-4-5 It is easy to deduce that patients with SAA who undergo a surgical aortic valve replacement (SAVR) are more likely to receive smaller prostheses, which makes them more predisposed to prosthesis patient-mismatch (PPM). This complication has been found to be associated with increases in perioperative, early-, mid-, and long-term mortality rates, 6,7 which leads to the necessity of implementation of surgical strategies to prevent PPM. Furthermore, worsening this scenario, surgical societies have raised serious concerns regarding inconsistencies in valve size labeling of prosthetic heart valves, 8 which might lead to higher rates of PPM in patients with SAA.…”

Section: Introductionmentioning

confidence: 99%

Aortic Valve Neocuspidization (Ozaki Procedure) in Patients with Small Aortic Annulus (≤21 mm): A Multicenter Study

et al. 2020

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Aortic Valve Neocuspidization (Ozaki Procedure) in Patients with Small Aortic Annulus (≤21 mm): A Multicenter Study

et al. 2020

View full text Add to dashboard Cite

“…Nevertheless, an association between both findings with higher morbidity due to higher gradients is possible and likely. Rayol et al (22) reported that PPM is a frequent and relevant hemodynamic complication of SAVR. Surgeons should prospectively calculate the predicted indexed EOA of the prosthesis and patient's body surface area (BSA) and hence plan their surgical procedure adequately; either with an aortic root enlargement (Nikcs-Nunez or Manougian technique) or with a rapid deployment surgical valve to avoid PPM.…”

Section: Follow-up and Outcomementioning

confidence: 99%

Transcatheter valve-in-valve implantation in degenerated aortic bioprostheses: are patients with small surgical bioprostheses at higher risk for unfavourable mid-term outcomes?

Pingpoh

Schroefel

Franz

et al. 2020

Ann Cardiothorac Surg

View full text Add to dashboard Cite

Background: To examine outcomes of valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) according to the inner diameter (ID) of the degenerated aortic valve bioprosthesis. Methods: We analyzed survival, stroke, permanent pacemaker (PPM) implantation, paravalvular (PV) leakage, acute kidney injury and vascular complications in fifty-nine patients during a ten-year period. Patients were stratified according to the ID of the indwelling degenerated biological aortic valve (true ID ≤ and >20 mm). Differences in post-procedural transvalvular gradients and hospital re-admissions were analyzed. Results: The median age of the small diameter group and large diameter group was eighty-one and eighty years, respectively. Median logistic EuroSCORE I was 23.9% and 26.2% and median Society of Thoracic Surgeons (STS) score was 5.7% and 7.8% for the small and large groups, respectively. Survival, stroke, PPM implantation, PV leakage, acute kidney injury and vascular complications did not reach any statistically significant difference between both groups. Postprocedural transvalvular gradients differed significantly according to the true ID of the degenerated bioprosthetic valve and consequently of the respective TAVI valve. There was a significant difference with regard to hospital readmissions according to the true ID. Conclusions: TAVI ViV implantation for aortic bioprostheses with small true IDs of ≤20 mm is associated with comparable mid-term mortality and periprocedural stroke rate compared to implantation into larger bioprostheses. However, the periprocedural and mid-term transvalvular gradients, as well as hospital re-admission rates are significantly higher in the small diameter group.

show abstract

“…Patient‐prosthesis mismatch (PPM) is defined as an effective orifice area (EOA) too small for the patient body surface area, mostly resulting in high residual transvalvular pressure gradients 1 . Severe PPM is associated with higher mortality, morbidity, rehospitalization rate, left ventricular workload, and reduced aortic prosthesis longevity 2–4 …”

Section: Introductionmentioning

confidence: 99%

“…1 Severe PPM is associated with higher mortality, morbidity, rehospitalization rate, left ventricular workload, and reduced aortic prosthesis longevity. [2][3][4] The reported prevalence of PPM after surgical aortic valve replacement (SAVR) is high but varies widely in the literature. A large meta-analysis of 34 observational studies and 27,186 patients found a prevalence of 44% (34% moderate PPM and 10% severe PPM).…”

Section: Introductionmentioning

confidence: 99%

Correlation between measured and predicted mismatch with valve hemodynamics in transcatheter aortic valve replacement: A sex‐based analysis

Natalis

Masson

Mansour

et al. 2023

Cathet Cardio Intervent

View full text Add to dashboard Cite

BackgroundData regarding the reliability of predicted effective orifice area indexed (pEOAi) is scarce in transcatheter aortic valve replacement (TAVR).AimsTo assess the validity of the pEOAi in TAVR by correlating its value with echocardiography‐derived hemodynamic data.MethodsA single‐center retrospective cohort study of TAVR patients from 2012 to 2021 with available echocardiograms was conducted. Patient‐prosthesis mismatch (PPM) was defined based on the Valve Academic Research Consortium 3 criteria. The main endpoints were the congruence of measured effective orifice area indexed (EOAi) and pEOAi with the hemodynamic data obtained by echocardiography. The secondary endpoint included a correlation of predicted PPM (pPPM) and measured PPM (mPPM) with postoperative New York Heart Association (NYHA) status.ResultsA total of 318 patients were included. pPPM was more frequent than mPPM (54 [17%]; all moderate PPM vs. 39 [12.3%]: 32 moderate and 7 severe PPM). Predicted and measured EOAi were statistically correlated with postprocedural transvalvular mean gradient and Doppler velocity index (all p < 0.001), including in both sex‐based subgroups. The positive predictive value and negative predictive value (NPV) of pPPM for postprocedural transvalvular mean gradient ≥ 20 mmHg were 16% and 97%, respectively. Only pPPM was significantly more prevalent in the group in which NYHA failed to improve than in those with symptom improvement (30.1% vs. 16%, p = 0.027).ConclusionPredicted PPM has an excellent NPV for postprocedural transvalvular mean gradient ≥ 20 mmHg and seems to be a good predictor of NYHA status evolution as opposed to measured PPM. Predicted EOAi can be used in procedural planning to reduce the risk of PPM in both TAVR male and female patients.

show abstract

Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement: Neither Uncommon nor Harmless

Cited by 10 publications

References 11 publications

Aortic Valve Neocuspidization (Ozaki Procedure) in Patients with Small Aortic Annulus (≤21 mm): A Multicenter Study

Aortic Valve Neocuspidization (Ozaki Procedure) in Patients with Small Aortic Annulus (≤21 mm): A Multicenter Study

Transcatheter valve-in-valve implantation in degenerated aortic bioprostheses: are patients with small surgical bioprostheses at higher risk for unfavourable mid-term outcomes?

Correlation between measured and predicted mismatch with valve hemodynamics in transcatheter aortic valve replacement: A sex‐based analysis

Contact Info

Product

Resources

About