Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement

Rao, Vivek; Jamieson, W.R. Eric; Ivanov, Joan; Armstrong, Susan; David, Tirone E.

doi:10.1161/01.cir.102.suppl_3.iii-5

Cited by 225 publications

(218 citation statements)

References 18 publications

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“…A key initiative in designing new valve prostheses is creating a favorable hemodynamic effect on the ventricle and ventricular reverse remodeling. 6 This focus in prosthesis development is further fueled by the finding that PPM (prosthesis considered too small for the patient, introducing functional obstruction to flow) increases mortality after AVR, 24 and impairs LV mass regression after both SAVR and TAVR. 17,25 This complicates the finding that LV mass regression is greater after SAVR given the significantly lower rate of PPM in TAVR and higher survival after CoreValve implantation compared to SAVR.…”

Section: Discussionmentioning

confidence: 99%

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

et al. 2017

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Section: Discussionmentioning

confidence: 99%

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

et al. 2017

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“…In a cohort of 2154 patients who underwent AVR, Rao et al 10 found that 30-day mortality was significantly higher (7.9% versus 4.6%; Pϭ0.03) in patients with evidence of moderate-severe PPM. In multivariate analysis, PPM was an independent predictor only of long-term valve-related mortality but not short-term mortality.…”

Section: Mismatch As a Predictor Of Short-term Mortalitymentioning

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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“…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). Within the past 10 years, there has been greater interest in PPM after MVR.…”

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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Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement

Cited by 225 publications

References 18 publications

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement

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

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

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