Valve prosthesis--patient mismatch. A long-term sequela.

Rahimtoola, Shahbudin H.; Murphy, Edward

doi:10.1136/hrt.45.3.331

Cited by 55 publications

(41 citation statements)

References 7 publications

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“…[2][3][4][5] As a consequence, normally functioning mitral prostheses often have relatively high gradients that are similar to those found in patients with mild to moderate mitral stenosis. [3][4][5][6][7] Residual pressure gradients across mitral prostheses may hinder or delay the regression of left atrial and pulmonary arterial hypertension. 3,8,9 The persistence of high left atrial pressures also may predispose to atrial dilatation and consequently atrial fibrillation.…”

Section: Editorial P 1336 Clinical Perspective P 1425mentioning

confidence: 91%

“…2,11,14,15,24 -26 However, the hemodynamic and clinical impact of PPM after MVR has been relatively unexplored. [3][4][5]8,9,23 Rahimtoola and Murphy 3 were the first to describe the case of a patient with PPM in the mitral position. In subsequent studies, Dumesnil et al 4 and Dumesnil and Yoganathan 5 showed that the indexed EOA of mitral prostheses should ideally not be less than 1.2 to 1.3 cm 2 /m 2 to avoid abnormally high residual transvalvular pressure gradients.…”

Section: Mechanisms Responsible For the Adverse Effect Of Ppmmentioning

confidence: 99%

“…[3][4][5][6][7] Residual pressure gradients across mitral prostheses may hinder or delay the regression of left atrial and pulmonary arterial hypertension. 3,8,9 The persistence of high left atrial pressures also may predispose to atrial dilatation and consequently atrial fibrillation. This arrhythmia may compromise cardiac output and increase the incidence of thromboembolic complications.…”

Section: Editorial P 1336 Clinical Perspective P 1425mentioning

confidence: 99%

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Impact of Prosthesis-Patient Mismatch on Survival After Mitral Valve Replacement

et al. 2007

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Background-We recently reported that valve prosthesis-patient mismatch (PPM) is associated with persisting pulmonary hypertension after mitral valve replacement. Thus, the objective of this study was to evaluate the impact of PPM on mortality in patients undergoing mitral valve replacement. Methods and Results-The indexed valve effective orifice area was estimated for each type and size of prosthesis being implanted in 929 consecutive patients and used to define PPM as not clinically significant if Ͼ1.2 cm 2 /m 2 , as moderate if Ͼ0.9 and Յ1.2 cm 2 /m 2 , and as severe if Յ0.9 cm 2 /m 2 . Moderate PPM was present in 69% of patients; severe PPM was seen in 9%. For patients with severe PPM, 6-year survival (74Ϯ5%) and 12-year survival (63Ϯ7%) were significantly less than for patients with moderate PPM (84Ϯ1% and 76Ϯ2%; Pϭ0.027) or nonsignificant PPM (90Ϯ2% and 82Ϯ4%; Pϭ0.002). On multivariate analysis, severe PPM was associated with higher mortality (hazard ratio, 3.2; 95% confidence interval, 1.5 to 6.8; Pϭ0.003). Conclusions-Severe PPM is an independent predictor of mortality after mitral valve replacement. As opposed to other independent risk factors, PPM may be avoided or its severity may be reduced with the use of a prospective strategy at the time of operation. For patients identified as being at risk for severe PPM, every effort should be made to implant a prosthesis with a larger effective orifice area.

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Section: Editorial P 1336 Clinical Perspective P 1425mentioning

confidence: 91%

Section: Mechanisms Responsible For the Adverse Effect Of Ppmmentioning

confidence: 99%

Section: Editorial P 1336 Clinical Perspective P 1425mentioning

confidence: 99%

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Impact of Prosthesis-Patient Mismatch on Survival After Mitral Valve Replacement

et al. 2007

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“…PPM has also been described in the mitral position. 50 It has been suggested that the indexed EOA of mitral prostheses should ideally be no less than 1.2 to 1.3 cm 2 /m 2 to avoid abnormally high postoperative gradients. 34,35 Depending on the study, 51-53 the reported prevalence for mitral PPM varies between 39% and 71% and was shown to be associated with persisting pulmonary hypertension 52 and decreased long-term survival.…”

Section: A Types Of Prosthetic Valvesmentioning

confidence: 99%

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound

Zoghbi¹,

Chambers²,

Dumesnil³

et al. 2009

Journal of the American Society of Echocardiography

1,147

357

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“…The concept of prosthesis-patient mismatch (PPM) was first described in 1978 by Rahimtoola et al 1,2) PPM occurs when the in vivo effective orifice area of the prosthetic valve is less than the native healthy valve area. 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.…”

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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Valve prosthesis--patient mismatch. A long-term sequela.

Cited by 55 publications

References 7 publications

Impact of Prosthesis-Patient Mismatch on Survival After Mitral Valve Replacement

Impact of Prosthesis-Patient Mismatch on Survival After Mitral Valve Replacement

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound

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

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