Patient-prosthesis mismatch can be predicted at the time of operation

Pîbarot, Philippe; Dumesnil, Jean G.; Cartier, P; Métras, Jacques; Lemieux, Michel

doi:10.1016/s0003-4975(01)02509-7

Cited by 132 publications

(126 citation statements)

References 7 publications

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“…This would also be the equivalent to the PPM levels. 3) While other studies focused on the impact of PPM on clinical outcome, the present study focused on the characteristics of the PPM patient group. Furthermore, this study revealed that the influence of characteristics on outcomes changed according to whether m-or r-EOAI was used.…”

Section: Discussionmentioning

confidence: 99%

“…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. [4][5][6][7][8][9][10][11][12][13][14] On the other hand, the focus of attention on PPM is its occurring after AVR instead of mitral valve replacement (MVR).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…The practical implications of these findings are important given that moderate-severe PPM is not a rare occurrence with a prevalence between 19 and 70% being reported in the literature. 4,12 Furthermore, as opposed to other predictors of short-term mortality, moderate-severe …”

Section: Discussionmentioning

confidence: 99%

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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“…In light of these recent data (66)(67)(68), every effort should be made to avoid prosthesis-patient mismatch in the patients with low-flow AS. The clinical implications of these findings are important given that prosthesis-patient mismatch is frequent (20% to 30%) after AVR and, as opposed to other risk factors, it can largely be avoided or its severity can be reduced with the use of a prospective strategy at the time of operation (36,(70)(71)(72)(73)(74).…”

Section: Management Of Patients With Ps Asmentioning

confidence: 99%

Patient-prosthesis mismatch can be predicted at the time of operation

Cited by 132 publications

References 7 publications

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

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

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

New concepts in valvular hemodynamics: Implications for diagnosis and treatment of aortic stenosis

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