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Molina-Lopez VH, Ortiz-Cartagena I, Mercado-Crespo J, Campos-Esteve MA. Optimizing Valve Selection in Valve-in-Valve Transcatheter Aortic Valve Replacement: A Case Study on Addressing Patient-Prosthesis Mismatch and Early Structural Valve Deterioration in a Morbidly Obese Patient. Cureus 2024; 16:e53191. [PMID: 38425595 PMCID: PMC10901697 DOI: 10.7759/cureus.53191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has increasingly become a fundamental approach for treating aortic valve stenosis (AVS), especially in high surgical risk patients. This case study underscores the criticality of meticulous procedural planning and precise valve selection in patients with severe AVS compounded by obesity. We report a case of a patient who, after receiving a 26 mm Edwards Sapiens 3 valve, presented with worsening exertional dyspnea and a declining indexed effective orifice area (EOAi). This deterioration indicated early structural valve deterioration (SVD), presumably due to patient-prosthesis mismatch (PPM). A subsequent valve-in-valve (ViV) TAVR using a 29 mm Medtronic Evolut Fx valve was successfully executed, leading to a notable improvement in EOAi. This case study emphasizes the complexities inherent in valve choice and sizing in TAVR, particularly highlighting the impact of PPM on obese patients and its potential to precipitate early SVD. The report further explores the emerging strategies in addressing TAVR valve dysfunctions via ViV interventions, shedding light on the nuanced and dynamic nature of TAVR management in obese patients. It advocates for tailored treatment strategies in managing such intricate cases, demonstrating the evolving landscape of TAVR procedures.
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Fazmin IT, Ali JM. Prosthesis-Patient Mismatch and Aortic Root Enlargement: Indications, Techniques and Outcomes. J Cardiovasc Dev Dis 2023; 10:373. [PMID: 37754802 PMCID: PMC10531615 DOI: 10.3390/jcdd10090373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Prosthesis-patient mismatch (PPM) is defined as implanting a prosthetic that is insufficiently sized for the patient receiving it. PPM leads to high residual transvalvular gradients post-aortic valve replacement and consequently results in left ventricular dysfunction, morbidity and mortality in both the short and long term. Younger patients and patients with poor preoperative left ventricular function are more vulnerable to increased mortality secondary to PPM. There is debate over the measurement of valvular effective orifice area (EOA) and variation exists in how manufacturers report the EOA. The most reliable technique is using in vivo echocardiographic measurements to create tables of predicted EOAs for different valve sizes. PPM can be prevented surgically in patients at risk through aortic root enlargement (ARE). Established techniques include the posterior enlargement through Nicks and Manouguian procedures, and aortico-ventriculoplasty with the Konno-Rastan procedure, which allows for a greater enlargement but carries increased surgical risk. A contemporary development is the Yang procedure, which uses a Y-shaped incision created through the non- and left-coronary cusp commissure, undermining the nadirs of the non- and left-coronary cusps. Early results are promising and demonstrate an ability to safely increase the aortic root by up to two to three sizes. Aortic root enlargement thus remains a valuable and safe tool in addressing PPM, and should be considered during surgical planning.
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Alnajar A, Hamad N, Azhar MZ, Mousa Y, Arora Y, Lamelas J. Surgical versus transcatheter aortic valve replacement: Impact of patient-prosthesis mismatch on outcomes. J Card Surg 2022; 37:5388-5394. [PMID: 36378858 DOI: 10.1111/jocs.17217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The hemodynamics of most prosthetic valves are often inferior to that of the normal native valve, and a significant proportion of patients undergoing surgical (SAVR) or transcatheter aortic valve replacement (TAVR) have high residual transaortic pressure gradients due to prosthesis-patient mismatch (PPM). As the experience with TAVR has increased and long-term outcomes are reported, a close look at the PPM literature is required in light of new evidence. METHODS For this review, we searched the Embase, Medline, and Cochrane databases from 2000 to 2022. Articles reporting PPM as an outcome following aortic valve replacements were identified and reviewed. RESULTS The impact of PPM on clinical outcomes in aortic valve replacement has not been clear as multiple studies failed to report PPM incidence. However, the PPM outcomes after SAVR vary more widely than after TAVR, ranging from 8% to 80% in SAVR and from 24% to 35% in TAVR. Incidence of severe PPM following redo SAVR ranges from 2% to 9% and following valve-in-valve TAVR is from 14% to 33%, however, while PPM is higher in valve-in-valve TAVR, patients had better survival rates. CONCLUSIONS The gap between valve performance and clinical outcomes in SAVR and TAVR could be reduced by carefully selecting patients for either treatment option. Understanding predictors of PPM can add to the safety, effectiveness, and increased survival benefit of both SAVR and TAVR.
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Affiliation(s)
- Ahmed Alnajar
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Naser Hamad
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Yaseen Mousa
- Florida Atlantic University, Boca Raton, Florida, USA
| | - Yingyot Arora
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Lamelas
- Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Personalised Treatment in Aortic Stenosis: A Patient-Tailored Transcatheter Aortic Valve Implantation Approach. J Cardiovasc Dev Dis 2022; 9:jcdd9110407. [PMID: 36421942 PMCID: PMC9694505 DOI: 10.3390/jcdd9110407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/13/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVI) has become a game changer in the management of severe aortic stenosis shifting the concept from inoperable or high-risk patients to intermediate or low surgical-risk individuals. Among devices available nowadays, there is no clear evidence that one device is better than the other or that one device is suitable for all patients. The selection of the optimal TAVI valve for every patient represents a challenging process for clinicians, given a large number of currently available devices. Consequently, understanding the advantages and disadvantages of each valve and personalising the valve selection based on patient-specific clinical and anatomical characteristics is paramount. This review article aims to both analyse the available devices in the presence of specific clinical and anatomic features and offer guidance to select the most suitable valve for a given patient.
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Kawaguchi T, Miyoshi T, Hayashi M, Ishizu K, Ugawa S, Nosaka K, Isotani A, Doi M, Shirai S, Ando K. Efficacy of larger valve sizing with underfilling in balloon-expandable transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2022; 99:2082-2091. [PMID: 35420255 DOI: 10.1002/ccd.30188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate the efficacy and safety of larger valve sizing beyond the commercially recommended annular range in transcatheter aortic valve replacement (TAVR) with balloon-expandable transcatheter heart valve (THVs). BACKGROUND The clinical implications of larger balloon-expandable THV implantation with underfilling are poorly evaluated. METHODS This retrospective study included 692 consecutive patients who underwent TAVR with SAPIEN3. A total of 271 patients who underwent SAPIEN 3 implantation were analyzed based on three border zones (Zone 1: 300-345 mm2 , 23 vs. 20 mm; Zone 2: 400-430 mm2 , 26 vs. 23 mm; Zone 3: 500-546 mm2 , 29 vs. 26 mm). The primary endpoint was the effective orifice area (EOA) assessed by echocardiography at 1 year, and secondary endpoints were a 30-day mortality rate, procedural complications during TAVR, and a composite of death from any cause and heart failure requiring rehospitalization at 1 year. RESULTS At 1-year follow-up, the EOA in the larger valve groups was greater than that in the recommended valve group in each zone (Zone 1: 1.45 ± 0.03 vs. 1.06 ± 0.06 cm2 , p < 0.001; Zone 2: 1.83 ± 0.05 vs. 1.41 ± 0.05 cm2 , p < 0.001; Zone 3: 1.93 ± 0.07 vs. 1.69 ± 0.07 cm2 , p = 0.02). No significant difference in the secondary endpoint was observed in any of the zones. CONCLUSIONS Implantation of the out-of-range larger SAPIEN 3 THVs with underfilling was associated with greater EOA at the 1-year follow-up and feasible in the selected patients.
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Affiliation(s)
- Tomohiro Kawaguchi
- Department of Cardiology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Toru Miyoshi
- Department of Cardiology, Okayama University Hospital, Okayama, Japan
| | - Masaomi Hayashi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenichi Ishizu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Satoko Ugawa
- Department of Cardiology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Kazumasa Nosaka
- Department of Cardiology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Akihiro Isotani
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masayuki Doi
- Department of Cardiology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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Aortic root widening: “pro et contra”. Indian J Thorac Cardiovasc Surg 2021; 38:91-100. [PMID: 35463701 PMCID: PMC8980977 DOI: 10.1007/s12055-020-01125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022] Open
Abstract
In patients with a small aortic annulus, the clinical benefits of aortic valve replacement depend on avoidance of patient-prosthesis mismatch as it is associated with reduced overall survival. Aortic root widening or enlargement is a useful technique to implant larger valve prosthesis to prevent patient-prosthesis mismatch. Posterior annular enlargement is the commonest technique used for aortic root enlargement. Consistent enlargement of the aortic root requires more extensive procedures like Manouguian or Konno-Rastan techniques. The patients commonly selected are younger patients with good life expectancy. However, caution is advised in applying this procedure in elderly patients, patients with heavily calcified annulus and when performing concomitant procedures. There is no definitive conclusion on the best material to use for the reconstruction of aortic annulus and aorta in aortic root enlargement procedures.
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7
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Catalano MA, Rutkin B, Koss E, Maurer G, Berg J, Hartman A, Yu PJ. Accuracy of predicted effective orifice area in determining incidence of patient-prosthesis mismatch after transcatheter aortic valve replacement. J Card Surg 2020; 36:191-196. [PMID: 33169868 DOI: 10.1111/jocs.15148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patient-prosthesis mismatch (PPM) is associated with poor outcomes after aortic valve replacement. The aim of this study was to assess the accuracy of indexed effective orifice area (EOAi) charts in predicting PPM after transcatheter aortic valve replacement (TAVR). METHODS A retrospective review of 346 TAVR patients from January 2017 to November 2018 was performed. EOAi was predicted for patients based on published predictive tables using valve type, annulus diameter, and body surface area. Actual EOAi was calculated based on intraoperative transesophageal echocardiogram (TEE) measurements. PPM was defined by EOAi ≤ 0.85 cm2 /m2 . The accuracy of predicted PPM was assessed. Differences in clinical outcomes, including mean gradient, length of stay, mortality, complications, and change in Kansas City cardiomyopathy questionnaire score as an indicator of quality of life, were evaluated based on actual PPM. RESULTS Of the 346 patients analyzed, 44 (12.7%) of patients had PPM on intraoperative TEE. Of the 182 patients who received Sapien 3 valves, 42 (23.1%) were predicted to have PPM while 25 (13.7%) had actual PPM. Of the 164 patients who received Evolut valves, 3 (1.8%) were predicted to have PPM while 19 (11.6%) had actual PPM. EOAi charts had poor sensitivity (40.0% for Sapien 3; 5.25% for Evolut) and positive predictive value (23.8% for Sapien 3; 33.3% for Evolut) for both valve types. CONCLUSION Preoperative prediction of PPM in TAVR patients using tables of expected EOA demonstrates significant variation from actual PPM. The utility of EOAi charts to predict PPM in patients undergoing TAVR may be limited.
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Affiliation(s)
- Michael A Catalano
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Bruce Rutkin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Elana Koss
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Greg Maurer
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Jacinda Berg
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Alan Hartman
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Pey-Jen Yu
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
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Panoulas VF, Chandrasekhar J, Busi G, Ruparelia N, Zhang Z, Mehilli J, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Sharma S, Ferrer‐Gracia M, Naber CK, Kievit PC, Snyder C, Sutaria N, Sen S, Malik IS, Morice M, Nihoyannopoulos P, Petronio AS, Mehran R, Chieffo A, Mikhail GW. Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing
TAVI
for severe aortic stenosis: Insights from the
WIN‐TAVI
registry. Catheter Cardiovasc Interv 2020; 97:516-526. [DOI: 10.1002/ccd.29227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Vasileios F. Panoulas
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Jaya Chandrasekhar
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Gherardo Busi
- Interventional cardiology unit San Raffaele Scientific Institute Milan Italy
| | - Neil Ruparelia
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
| | - Zhongjie Zhang
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Julinda Mehilli
- Department of cardiology Ludwig‐Maximilians‐University of Munich Munich Germany
| | - Samantha Sartori
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Thierre Lefèvre
- Institut Cardiovasculaire Paris Sud Hôpital privé Jacques cartier, Ramsay Générale de santé Massy France
| | - Patrizia Presbitero
- Department of Cardiology IRCCS Humanitas Clinical and Research Centre Milan Italy
| | | | | | - Alessandro Iadanza
- Emodinamica Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte Siena Italy
| | - Gennaro Sardella
- Interventional cardiology unit Policlinico “Umberto I Rome Italy
| | - Nicolas M. Van Mieghem
- Department of interventional cardiology Erasmus Medical Center, Thoraxcenter Rotterdam The Netherlands
| | - Emanuele Meliga
- Interventional cardiology unit Mauriziano Hospital Turin Italy
| | | | - Chiara Fraccaro
- Interventional cardiology unit University of Padova Padova Italy
| | - Daniela Trabattoni
- Invasive Cardiology Unit 3 Centro Cardiologico Monzino, IRCCS Milan Italy
| | - Samin Sharma
- Department of cardiology Mount Sinai Hospital New York New York USA
| | - Maria‐Cruz Ferrer‐Gracia
- Department of Cardiology, Interventional Cardiology Unit Hospital Universitario Miguel Servet Zaragoza Spain
| | - Christoph K. Naber
- Department of cardiology Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen Germany
| | - Peter C. Kievit
- Department of cardiology Radboud University Nijmegen Medical Center Nijmegan, The Netherlands
| | - Clayton Snyder
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Nilesh Sutaria
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
| | - Sayan Sen
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Iqbal S. Malik
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Marie‐Claude Morice
- Department of cardiology Ludwig‐Maximilians‐University of Munich Munich Germany
| | - Petros Nihoyannopoulos
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Anna Sonia Petronio
- Interventional cardiology unit AOUP Cisanello, University Hospital Pisa Italy
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Alaide Chieffo
- Interventional cardiology unit San Raffaele Scientific Institute Milan Italy
| | - Ghada W. Mikhail
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
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9
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Dahlbacka S, Laakso T, Kinnunen EM, Moriyama N, Laine M, Virtanen M, Maaranen P, Ahvenvaara T, Tauriainen T, Husso A, Jalava M, Jaakkola J, Airaksinen J, Valtola A, Niemelä M, Mäkikallio T, Eskola M, Vento A, Juvonen T, Biancari F, Raivio P. Patient-Prosthesis Mismatch Worsens Long-Term Survival: Insights From the FinnValve Registry. Ann Thorac Surg 2020; 111:1284-1290. [PMID: 32805269 DOI: 10.1016/j.athoracsur.2020.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/22/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of patient-prosthesis mismatch (PPM) on long-term outcome after surgical aortic valve replacement (SAVR) is controversial. We sought to investigate the incidence of PPM and its impact on survival and reinterventions in a Finnish nationwide cohort. METHODS In the context of the nationwide FinnValve registry, we identified 4097 patients who underwent SAVR with a stented bioprosthesis with or without myocardial revascularization. The indexed effective orifice areas (EOAs) of surgical bioprostheses were calculated using literature-derived EOAs. PPM was graded as moderate (EOA 0.65-0.85 cm2/m2) or severe (EOA ≤0.65 cm2/m2). RESULTS The incidence of PPM was 46.0%. PPM was moderate in 38.8% (n = 1579) patients and severe in 7.2% (n = 297) patients. Time-trend analysis showed that the proportion of PPM decreased significantly from 74% in 2009 to 18% in 2017 (P < .01). Severe PPM was associated with increased 5-year all-cause mortality (adjusted hazard ratio [HR], 1.72; 95% confidence interval [CI], 1.07-2.76; P = .02). Severe PPM was not associated with an increased risk of repeat AVR (adjusted HR, 5.90; 95% CI, 0.95-36.5; P = .06). In a subanalysis of patients greater than or equal to 70 years of age, in comparison with no PPM, any PPM (adjusted HR, 1.23; 95% CI, 1.05-1.45; P = .01) and severe PPM (HR, 1.53; 95% CI, 1.17-2.00; P < 0.01) were associated with increased risk of 5-year mortality. CONCLUSIONS Severe PPM after SAVR had a negative impact on survival. This study demonstrated that the effects of PPM should not be overlooked in elderly undergoing SAVR.
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Affiliation(s)
| | - Teemu Laakso
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | - Noriaki Moriyama
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Marko Virtanen
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuomas Ahvenvaara
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tuomas Tauriainen
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland
| | | | - Maina Jalava
- Heart Center, Turku University Hospital University of Turku, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland
| | - Jussi Jaakkola
- Heart Center, Turku University Hospital University of Turku, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital University of Turku, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Timo Mäkikallio
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Antti Vento
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland, Finland
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Heart Center, Turku University Hospital University of Turku, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland; Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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10
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He S, Fang Z. Incidence, predictors, and outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement: A meta-analysis. Medicine (Baltimore) 2020; 99:e20717. [PMID: 32541522 PMCID: PMC7302587 DOI: 10.1097/md.0000000000020717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/14/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR) is common, but the incidence, predictors and outcome of PPM are still controversial. METHODS A total of 18 articles incorporating 72,016 patients were identified form PubMed and Embase online database. RESULTS The pooled incidences of overall, and severe PPM following TAVR were 32.0% and 10.0% separately. Comparing to surgical aortic valve replacement (SAVR), TAVR had lower incidence of overall (OR, 0.31, 95% CI, 0.20-0.50) and severe PPM (OR, 0.38, 95% CI, 0.28-0.52). PPM was associated with a larger body surface area (BSA), larger body mass index (BMI) and previous myocardial infarction in comparison with those patients without PPM. Although PPM was not rare after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.51, 95% CI, 0.79-2.87, 1 year: OR: 1.02, 95% CI, 0.96-1.08, and 2 years: OR: 0.99, 95% CI, 0.79-1.24) between patients with PPM and those without PPM. CONCLUSIONS Despite the fact that the incidence of PPM was lower than that of SAVR, PPM was not seen to have an impact on short- and mid-term survival.
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11
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Elmahdy W, Osman M, Farag M, Shoaib A, Saad H, Sullivan K, Krishnan U, Nashef S, Berman M. Prosthesis-Patient Mismatch Increases Early and Late Mortality in Low Risk Aortic Valve Replacement. Semin Thorac Cardiovasc Surg 2020; 33:23-30. [PMID: 32439547 DOI: 10.1053/j.semtcvs.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/11/2022]
Abstract
The concept of prosthesis-patient mismatch (PPM) has gained much attention since first described 40 years ago. Previous studies have shown conflicting evidence regarding increased early and late morbidity and mortality with PPM after aortic valve replacement (AVR). The aim of this study was to evaluate the effects of PPM on short- and long-term mortality in low-risk patients after isolated AVR. A retrospective, single-center study involving 1707 consecutive patients ≤80 years of age with preserved left ventricular systolic function who underwent elective, primary isolated AVR operations from 2008 to 2018. Patients were stratified into 2 groups according to the presence of PPM (n = 96), defined as effective orifice area index <0.85 cm2/m2 body surface area, and no-PPM (n = 1611). The effect of PPM on mortality was evaluated with univariate and multivariate analyses. 30-day mortality was 0.8% (4.2% in PPM group vs 0.6 in no-PPM group; P = 0.005). PPM occurred more in female gender, obese and older patients. PPM was highly associated with long-term all-cause mortality (median 4 years [Q1-Q3 2-7]; HR: 1.79, 95% CI: 1.27-2.55, P = 0.002), and remained strongly and independently associated after adjustment for other risk factors (HR: 1.60, 95% CI: 1.10-2.34, P = 0.014). In propensity score-matched analysis, the adjusted mortality risk was higher in PPM group (HR: 2.03, 95% CI: 1.22-3.39, P = 0.006) compared to no-PPM group. In a single-centre observational study, PPM increased early mortality and was independently associated with long-term all-cause mortality after low-risk, primary isolated AVR operations. Strategies to avoid PPM should be explored and implemented.
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Affiliation(s)
- Walid Elmahdy
- Royal Papworth Hospital, Cardiac Surgery Department, Cambridge Biomedical Campus, Cambridge, UK
| | - Mohamed Osman
- Royal Papworth Hospital, Cardiac Surgery Department, Cambridge Biomedical Campus, Cambridge, UK.
| | - Mohamed Farag
- Royal Papworth Hospital, Cardiology Department, Cambridge Biomedical Campus, Cambridge, UK; School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | | | - Haisam Saad
- Royal Papworth Hospital, Cardiac Surgery Department, Cambridge Biomedical Campus, Cambridge, UK
| | - Keith Sullivan
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Unni Krishnan
- Royal Papworth Hospital, Cardiology Department, Cambridge Biomedical Campus, Cambridge, UK
| | - Samer Nashef
- Royal Papworth Hospital, Cardiac Surgery Department, Cambridge Biomedical Campus, Cambridge, UK
| | - Marius Berman
- Royal Papworth Hospital, Cardiac Surgery Department, Cambridge Biomedical Campus, Cambridge, UK
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12
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Kim HJ, Park SJ, Koo HJ, Kang JW, Yang DH, Jung SH, Choo SJ, Chung CH, Lee JW, Kim JB. Determinants of effective orifice area in aortic valve replacement: anatomic and clinical factors. J Thorac Dis 2020; 12:1942-1951. [PMID: 32642097 PMCID: PMC7330291 DOI: 10.21037/jtd-20-188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Obtaining adequate effective orifice area (EOA) in surgical aortic valve replacement (SAVR) is important to minimize pressure gradients across the prosthetic aortic valve (AV) and improve clinical outcomes. However, the predictors of EOA are unclear. Methods From July 2011 to March 2016, patients undergoing SAVR who were preoperatively evaluated using a computed tomography (CT) on the aortic root were enrolled. Indexed EOA (iEOA) was used as an indicator of prosthetic AV opening area. The aortic root parameters investigated were the annular diameter (max and min), annular perimeter, annular area, and maximal dimensions of the proximal ascending aorta. These variables were evaluated as predictors of EOA, and an individual surgeon was incorporated in analysis for verifying surgeon dependent factors. Results Among the 710 patients included in this study [age: 64.9±10.8 years; females: n=285 (40.1%)], 370 (52.1%) were implanted with bio-prosthesis. Mean prosthetic iEOA was 1.1±0.3 cm2/m2. Univariable linear regression analysis showed that all indexed aortic root parameters (maximal and minimal annular diameters, annular perimeter, annular area, and sinus dimensions) were significantly associated with iEOA (P<0.001). Multivariable analysis showed that indexed aortic annular area, indexed maximal diameter of the Valsalva sinus, female sex, and bio-prosthesis, supra-annular type prosthesis and surgeon were significant and independent determinants of iEOA (adjusted R2=0.513, P<0.001). Conclusions Aortic annular area and Valsalva sinus diameter are independent determinants for iEOA measured by preoperative CT; surgeon-dependent factors are also significant determinants in SAVR.
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Affiliation(s)
- Hee Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University, Seoul, Korea
| | - Sung Jun Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging 2020; 12:149-162. [PMID: 30621987 DOI: 10.1016/j.jcmg.2018.10.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 11/21/2022]
Abstract
Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthetic valve is too small in relation to a patient's body size, thus resulting in high residual postoperative pressure gradients across the prosthesis. Severe PPM occurs in 2% to 20% of patients undergoing surgical aortic valve replacement (AVR) and is associated with 1.5- to 2.0-fold increase in the risk of mortality and heart failure rehospitalization. The purpose of this article is to present an overview of the role of multimodality imaging in the assessment, prediction, prevention, and management of PPM following AVR. The risk of PPM can be anticipated at the time of AVR by calculating the predicted indexed from the normal reference value of EOA of the selected prosthesis and patient's body surface area. The strategies to prevent PPM at the time of surgical AVR include: 1) implanting a newer generation of prosthetic valve with better hemodynamic; 2) enlarging the aortic root or annulus to accommodate a larger prosthetic valve; or 3) performing TAVR rather than surgical AVR. The identification and quantitation of PPM as well as its distinction versus prosthetic valve stenosis is primarily based on transthoracic echocardiography, but important information may be obtained from other imaging modalities such as transesophageal echocardiography and multidetector computed tomography. PPM is characterized by high transprosthetic velocity and gradients, normal EOA, small indexed EOA, and normal leaflet morphology and mobility. Transesophageal echocardiography and multidetector computed tomography are particularly helpful to assess prosthetic valve leaflet morphology and mobility, which is a cornerstone of the differential diagnosis between PPM and pathologic valve obstruction. Severe symptomatic PPM following AVR with a bioprosthetic valve may be treated by redo surgery or the transcatheter valve-in-valve procedure with fracturing of the surgical valve stent.
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14
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Kawaguchi T, Yamaji K, Ishizu K, Morinaga T, Hayashi M, Isotani A, Kakumoto S, Arai Y, Sakaguchi G, Shirai S, Ando K. Effect of postdilatation following balloon expandable transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2019; 96:E630-E639. [DOI: 10.1002/ccd.28676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | - Kyohei Yamaji
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Kenichi Ishizu
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Takashi Morinaga
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Masaomi Hayashi
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Akihiro Isotani
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Shinichi Kakumoto
- Department of Anesthesiology Kokura Memorial Hospital Kitakyushu Japan
| | - Yoshio Arai
- Department of Cardiovascular Surgery Kokura Memorial Hospital Kitakyushu Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery Kokura Memorial Hospital Kitakyushu Japan
| | - Shinichi Shirai
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Kenji Ando
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
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15
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Stamou SC, Chen K, James TM, Rothenberg M, Kapila A, Faber C, Nores MA. Predictors and outcomes of patient‐prosthesis mismatch after transcatheter aortic valve replacement. J Card Surg 2019; 35:360-366. [DOI: 10.1111/jocs.14383] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sotiris C Stamou
- Department of Cardiovascular SurgeryJFK Medical Center Atlantis Florida
| | - Kai Chen
- Department of Cardiovascular SurgeryJFK Medical Center Atlantis Florida
| | - Taylor M James
- Department of Cardiovascular SurgeryJFK Medical Center Atlantis Florida
| | - Mark Rothenberg
- Department of Cardiovascular SurgeryJFK Medical Center Atlantis Florida
| | - Arvind Kapila
- Department of Cardiovascular SurgeryJFK Medical Center Atlantis Florida
| | - Cristiano Faber
- Department of Cardiovascular SurgeryJFK Medical Center Atlantis Florida
| | - Marcos A Nores
- Department of Cardiovascular SurgeryJFK Medical Center Atlantis Florida
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16
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Sá MPBO, Carvalho MMB, Sobral Filho DC, Cavalcanti LRP, Diniz RGS, Rayol SC, Soares AMMN, Sá FBCDA, Menezes AM, Clavel MA, Pibarot P, Lima RC. Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients. Interact Cardiovasc Thorac Surg 2019; 29:74-82. [DOI: 10.1093/icvts/ivy364] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/19/2018] [Accepted: 11/11/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michel Pompeu Barros Oliveira Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite – FCM/ICB, Recife, Brazil
| | - Martinha Milliany Barros Carvalho
- University of Pernambuco – UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite – FCM/ICB, Recife, Brazil
| | - Dário Celestino Sobral Filho
- University of Pernambuco – UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite – FCM/ICB, Recife, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | - Roberto Gouvea Silva Diniz
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | - Sérgio Costa Rayol
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | - Alexandre Magno Macário Nunes Soares
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | | | - Alexandre Motta Menezes
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie e de Pneumologie du Québec, Quebec City, QC, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie e de Pneumologie du Québec, Quebec City, QC, Canada
| | - Ricardo Carvalho Lima
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite – FCM/ICB, Recife, Brazil
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17
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León del Pino MDC, Ruíz Ortiz M, Delgado Ortega M, Sánchez Fernández J, Ferreiro Quero C, Durán Jiménez E, Romero Moreno M, Segura Saint-Gerons J, Ojeda Pineda S, Pan Álvarez-Ossorio M, Mesa Rubio D. Prosthesis-patient mismatch after transcatheter aortic valve replacement: prevalence and medium term prognostic impact. Int J Cardiovasc Imaging 2019; 35:827-836. [DOI: 10.1007/s10554-018-01519-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/24/2018] [Indexed: 01/01/2023]
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18
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Sá MPBDO, de Carvalho MMB, Sobral Filho DC, Cavalcanti LRP, Rayol SDC, Diniz RGS, Menezes AM, Clavel MA, Pibarot P, Lima RC. Surgical aortic valve replacement and patient–prosthesis mismatch: a meta-analysis of 108 182 patients. Eur J Cardiothorac Surg 2019; 56:44-54. [DOI: 10.1093/ejcts/ezy466] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
This study sought to evaluate the impact of patient–prosthesis mismatch (PPM) on the risk of perioperative, early-, mid- and long-term mortality rates after surgical aortic valve replacement.
METHODS
Databases were searched for studies published until March 2018. The main outcomes of interest were perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality.
RESULTS
The search yielded 3761 studies for inclusion. Of these, 70 articles were analysed, and their data were extracted. The total number of patients included was 108 182 who underwent surgical aortic valve replacement. The incidence of PPM after surgical aortic valve replacement was 53.7% (58 116 with PPM and 50 066 without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95% confidence interval (CI) 1.302–1.707; P < 0.001], 1-year mortality (OR 1.465, 95% CI 1.277–1.681; P < 0.001), 5-year mortality (OR 1.358, 95% CI 1.218–1.515; P < 0.001) and 10-year mortality (OR 1.534, 95% CI 1.290–1.825; P < 0.001) were increased in patients with PPM. Both severe PPM and moderate PPM were associated with increased risk of perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality when analysed together and separately, although we observed a higher risk in the group with severe PPM.
CONCLUSIONS
Moderate/severe PPM increases perioperative, early-, mid- and long-term mortality rates proportionally to its severity. The findings of this study support the implementation of surgical strategies to prevent PPM in order to decrease mortality rates.
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Affiliation(s)
- Michel Pompeu Barros de Oliveira Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Martinha Millianny Barros de Carvalho
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Dário Celestino Sobral Filho
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Sérgio da Costa Rayol
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Roberto Gouvea Silva Diniz
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Alexandre Motta Menezes
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Canada
| | - Ricardo Carvalho Lima
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
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19
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Fallon JM, DeSimone JP, Brennan JM, O’Brien S, Thibault DP, DiScipio AW, Pibarot P, Jacobs JP, Malenka DJ. The Incidence and Consequence of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement. Ann Thorac Surg 2018; 106:14-22. [DOI: 10.1016/j.athoracsur.2018.01.090] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/25/2017] [Accepted: 01/18/2018] [Indexed: 10/17/2022]
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20
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Gonzalez-Lopez D, Faerber G, Diab M, Amorim P, Zeynalov N, Doenst T. Replica sizing strategy for aortic valve replacement improves haemodynamic outcome of the epic supra valve. Interact Cardiovasc Thorac Surg 2017; 25:509-512. [DOI: 10.1093/icvts/ivx234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/29/2017] [Indexed: 11/14/2022] Open
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21
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Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging 2016; 9:924-33. [DOI: 10.1016/j.jcmg.2015.10.026] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022]
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22
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Suh YJ, Lee S, Im DJ, Chang S, Hong YJ, Lee HJ, Hur J, Choi BW, Chang BC, Shim CY, Hong GR, Kim YJ. Added value of cardiac computed tomography for evaluation of mechanical aortic valve: Emphasis on evaluation of pannus with surgical findings as standard reference. Int J Cardiol 2016; 214:454-60. [DOI: 10.1016/j.ijcard.2016.04.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/11/2016] [Accepted: 04/02/2016] [Indexed: 12/12/2022]
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23
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Takagi H, Umemoto T. Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Implantation. Ann Thorac Surg 2016; 101:872-80. [DOI: 10.1016/j.athoracsur.2015.11.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/10/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
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24
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Thalji NM, Suri RM, Michelena HI, Greason KL, Dearani JA, Daly RC, Joyce LD, Stulak JM, Burkhart HM, Li Z, Schaff HV. Do differences in early hemodynamic performance of current generation biologic aortic valves predict outcomes 1 year following surgery? J Thorac Cardiovasc Surg 2015; 149:163-73.e2. [DOI: 10.1016/j.jtcvs.2014.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/25/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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25
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Boulogne C, Mohty D. Aortic prosthesis-patient mismatch in patients with paradoxical low flow severe aortic stenosis: a dreadful combination. Arch Cardiovasc Dis 2014; 108:1-4. [PMID: 25534885 DOI: 10.1016/j.acvd.2014.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Cyrille Boulogne
- CHU de Limoges, hôpital Dupuytren, pôle « Cœur-Poumon-Rein », service de cardiologie, 87042 Limoges, France
| | - Dania Mohty
- CHU de Limoges, hôpital Dupuytren, pôle « Cœur-Poumon-Rein », service de cardiologie, 87042 Limoges, France.
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26
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Mohty D, Boulogne C, Magne J, Pibarot P, Echahidi N, Cornu E, Dumesnil J, Laskar M, Virot P, Aboyans V. Prevalence and long-term outcome of aortic prosthesis-patient mismatch in patients with paradoxical low-flow severe aortic stenosis. Circulation 2014; 130:S25-31. [PMID: 25200051 DOI: 10.1161/circulationaha.113.007819] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis-patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS. METHODS AND RESULTS Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm(2)). A PLF (indexed stroke volume ≤35 mL/m(2)) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area ≤0.85 cm(2)/m(2). The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P<0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P=0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5-4.45; P=0.0007). CONCLUSIONS In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome.
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Affiliation(s)
- Dania Mohty
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
| | - Cyrille Boulogne
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
| | - Julien Magne
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
| | - Philippe Pibarot
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
| | - Najmeddine Echahidi
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
| | - Elisabeth Cornu
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
| | - Jean Dumesnil
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
| | - Marc Laskar
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
| | - Patrice Virot
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
| | - Victor Aboyans
- From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.)
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Vernick WJ. Con: patient-prosthesis mismatch now is not an important consideration in the majority of patients after aortic valve replacement. J Cardiothorac Vasc Anesth 2013; 28:184-188. [PMID: 24183317 DOI: 10.1053/j.jvca.2013.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Indexed: 11/11/2022]
Affiliation(s)
- William J Vernick
- Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA.
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Honda K, Okamura Y. Prosthesis-patient mismatch in aortic stenosis. Gen Thorac Cardiovasc Surg 2013; 62:78-86. [PMID: 24132681 DOI: 10.1007/s11748-013-0331-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The clinical impacts of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) have been debated since Rahimtoola first reported PPM in 1978. Many reports discussing several aspects of PPM have been published to date, but the definitive clinical impacts of PPM have not yet been clarified. PURPOSE The purpose of this review is to evaluate recent articles regarding PPM and discuss the latest findings. RESULTS Moderate PPM (indexed effective orifice area ≤ 0.85 cm(2)/m(2)) did not affect the surgical outcomes in several papers, but severe PPM (indexed effective orifice area ≤ 0.65 cm(2)/m(2)) affected early and late mortality in almost of the all papers in which it was reported. PPM had a greater effect on younger patients and patients with left ventricular dysfunction than it did on elderly patients and patients with preserved left ventricular function. CONCLUSION Based on recent findings, it is difficult to define the impact of PPM after AVR. To some degree, PPM affects the clinical outcomes after AVR; therefore, it is important to avoid PPM, especially severe PPM.
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Affiliation(s)
- Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan,
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Sakamoto Y, Hashimoto K. Update on aortic valve prosthesis-patient mismatch in Japan. Gen Thorac Cardiovasc Surg 2013; 61:669-75. [PMID: 23585189 DOI: 10.1007/s11748-013-0243-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 10/27/2022]
Abstract
The influence of aortic valve prosthesis-patient mismatch (VP-PM) on the clinical outcome has been an ongoing controversy. The reported prevalence of VP-PM after aortic valve replacement (AVR) ranges widely between 20 and 70 %. The inconsistent impact of VP-PM on short-term and long-term mortality, regression of left ventricular (LV) hypertrophy, and exercise capacity may be explained by differences of the patient populations, the definition of VP-PM, and the use of different prostheses. Moreover, many factors other than the severity of VP-PM should be taken into account when considering its impact on individual patients after AVR. Although the concept of VP-PM is easy to understand, it cannot be applied to the whole patient population. In Japan, the age of the candidates for AVR has increased markedly in recent years, but almost all elderly patients with a small BSA (<1.6 m(2)) have received newer-generation prostheses with a small outer diameter and large effective orifice area. Indeed, previous studies of Japanese patients have demonstrated that VP-PM was no more than moderate in most cases and its impact on clinical outcomes was generally acceptable. Although severe VP-PM is infrequent and its clinical implications are still unproven in elderly Japanese patients, it would seem reasonable to try to prevent severe VP-PM. Thus, VP-PM itself cannot be accepted as an independent risk factor in Japanese patients, but the useful preventive strategies for severe VP-PM in inactive very elderly persons remain controversial. The implantation of newer-generation biological or mechanical prostheses with or without aortic annular enlargement should be considered according to the characteristics of the patient and the risk-benefit ratio for carrying out a particular procedure in an individual patient.
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Affiliation(s)
- Yoshimasa Sakamoto
- Department of Cardiac Surgery, The Jikei University, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan,
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Muñoz-García AJ, Muñoz-García M, Carrasco-Chinchilla F, Molina-Mora MJ, Rodríguez-Bailón I, Domínguez-Franco AJ, Jiménez-Navarro MF, Alonso-Briales JH, Gómez-Doblas JJ, Hernández-García JM, de Teresa-Galván E. Incidence and clinical outcome of prosthesis-patient mismatch after transcatheter aortic valve implantation with the CoreValve prosthesis. Int J Cardiol 2012; 167:1074-6. [PMID: 23164585 DOI: 10.1016/j.ijcard.2012.10.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/28/2012] [Indexed: 11/27/2022]
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Pibarot P, Dumesnil JG. Valve Prosthesis–Patient Mismatch, 1978 to 2011. J Am Coll Cardiol 2012; 60:1136-9. [DOI: 10.1016/j.jacc.2012.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 06/27/2012] [Accepted: 07/02/2012] [Indexed: 10/27/2022]
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