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Miyasaka M, Tada N. Prosthesis-patient mismatch after transcatheter aortic valve implantation. Cardiovasc Interv Ther 2022; 37:615-625. [PMID: 35708855 DOI: 10.1007/s12928-022-00865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 01/22/2023]
Abstract
Prosthesis-patient mismatch (PPM), first described in 1978, occurs when a prosthetic valve functions normally, but has an effective orifice area that is too small relative to the patient's body surface area. It results in residual left ventricular afterload and higher transvalvular pressure gradient, which has been considered to impair prognosis. PPM following surgical aortic replacement is reportedly associated with worse clinical outcomes, such as high mortality. However, the impact of PPM on clinical outcomes after transcatheter aortic valve implantation (TAVI) remains unclear. There is conflicting evidence on the impact of PPM following TAVI due to differences across studies in terms of follow-up period, methods, patient populations, and type of bioprosthetic valve. The present review summarizes the most recent evidence on PPM after TAVI.
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Affiliation(s)
- Masaki Miyasaka
- Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, Japan. .,Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan.
| | - Norio Tada
- Cardiovascular Center, Sendai Kosei Hospital, Miyagi, Japan
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2
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Singh R, Kapoor PM, Prakash M. Patient Prosthesis Mismatch. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1750115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractConcept of patient prosthesis mismatch came into existence from 1978 onward when Rahimtoola first defined it as “mismatch can be considered to be present when the effective prosthetic valve area, after insertion into the patient, is less than that of a normal human valve.” Patient prosthesis mismatch produces higher than expected pressure gradient through normally functioning valve. Since insertion of first ball caged mechanical valve in descending aorta by Dr. Charles Hufnagel in 1952, prosthetic valve had undergone tremendous improvement in terms of valve design, hemodynamics, durability, and thrombogenicity. Despite these marked changes in valve design, prosthetic valves are still subjected to inherent complications.
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Affiliation(s)
- Rashmi Singh
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Prakash
- Department of Cardiac Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Bleiziffer S, Rudolph TK. Patient Prosthesis Mismatch After SAVR and TAVR. Front Cardiovasc Med 2022; 9:761917. [PMID: 35433878 PMCID: PMC9005892 DOI: 10.3389/fcvm.2022.761917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022] Open
Abstract
Patient-prosthesis mismatch (PPM) remains one out of many factors to be considered during decision-making for the treatment of aortic valve pathologies. The idea of adequate sizing of a prosthetic heart valve was established by Rahimtoola already in 1978. In this article, the author described the phenomenon that the orifice area of a prosthetic heart valve may be too small for the individual patient. PPM is assessed by measurement or projection of the prosthetic effective orifice area indexed to body surface area (iEOA), while it is recommended to use different cut point values for non-obese and obese patients for the categorization of moderate and severe PPM. Several factors influence the accuracy of both the projected and the measured iEOA for PPM assessment, which leads to a certain number of false assignments to the PPM or no PPM group. Despite divergent findings on the impact of PPM on clinical outcomes, there is consensus that PPM should be avoided to prevent sequelae of increased prosthetic gradients after aortic valve replacement. To prevent PPM, it is required to anticipate the iEOA of the prosthesis prior to the procedure. The use of adequate reference tables, derived from echocardiographically measured mean effective orifice area (EOA) values from preferably large numbers of patients, is most appropriate to predict the iEOA. Such tables should be used also for transcatheter heart valves in the future. During the decision-making process, all available options should be taken into account for the individual patient. If the predicted size and type of a surgical prosthesis cannot be implanted, additional surgical procedures, such as annular enlargement with the Manougian technique, or alternative procedures, such as transcatheter aortic valve implantation (TAVI) can prevent PPM. PPM prevention for TAVI patients is a new field of interest and includes anticipation of the iEOA, prosthesis selection, and procedural strategies.
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Affiliation(s)
- Sabine Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
- *Correspondence: Sabine Bleiziffer
| | - Tanja K. Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Bad Oeynhausen, Germany
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Patient–Prosthesis Mismatch in Contemporary Small-Size Mechanical Prostheses Does Not Impact Survival at 10 Years. J Cardiovasc Dev Dis 2022; 9:jcdd9020048. [PMID: 35200701 PMCID: PMC8877093 DOI: 10.3390/jcdd9020048] [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: 12/03/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The effect of PPM in mechanical prostheses on long-term survival is not well-established. Methods: Patients who received a 21 mm or smaller aortic valve between 2000 and 2011 were retrospectively analyzed (n = 416). Propensity matching was used in order to account for baseline differences in patient subgroups (PPM vs. no PPM; severe PPM vs. no severe PPM). Results: Five- and ten-year survival was 78 ± 3.52% and 64.51 ± 4.51% in patients with PPM, versus 83.3 ± 3.12% and 69.37 ± 4.36% in patients without (p = 0.28) when analyzed at 10.39 ± 5.25 years after the primary procedure. Independent risk factors for impaired survival, after matching, were age, serum creatinine, and severe pulmonary hypertension. Five- and ten-year survival in patients with severe PPM was 73.34 ± 6.01% and 61.76 ± 8.17%, respectively, versus 74.72 ± 5.68% and 67.50 ± 7.09% in those without (p = 0.49), at 8.82 ± 5.17 years after SAVR. Age was the only independent variable that influenced long-term survival when severe PPM was added to the model. Conclusions: PPM or severe PPM does not impact long-term survival up to 10 years in mechanical valve recipients when matching for preoperative variables.
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Vallabhaneni S, Matka M, Modi V, Carey M, Sarnoski C, Durkin R, Olenchock S, Razzaghi M, Shirani J. Prevalence and Significance of Patient Prosthesis Mismatch Following Edwards SAPIEN XT and SAPIEN 3 Transcatheter Aortic Valve Replacement. Cureus 2021; 13:e18044. [PMID: 34692277 PMCID: PMC8523339 DOI: 10.7759/cureus.18044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background Severe patient prosthesis mismatch (sPPM) after surgical aortic valve replacement is associated with worse outcomes. Limited data exists on the impact of sPPM on outcomes after transcatheter aortic valve replacement (TAVR), especially regarding the newer generation valves. The aim of this study was to evaluate the incidence, determinants, and outcomes of sPPM in patients undergoing TAVR with Edwards SAPIEN XT (ES XT) and Edwards SAPIEN 3 (ES3) valves (Edwards Lifesciences, Irvine, CA, USA). Methods We retrospectively reviewed 366 patients who underwent TAVR with ES XT (n = 114) or ES3 (n = 252) valves between July 2012 and June 2018. sPPM was defined as indexed effective orifice area (iEOA) <0.65 cm2/m2. Kaplan-Meier survival estimates were used to determine outcomes. Results Multivariate linear regression analysis was utilized to determine potential independent effects of PPM on outcomes. sPPM was present in 40 (11%) of the patients [8 (7%) ES XT and 32 (13%) ES3] and was associated with female sex, smaller left ventricular outflow tract (LVOT) diameter and aortic valve annular area, absence of prior coronary artery bypass graft (CABG) surgery, shorter height, higher body mass index, and smaller pre-TAVR valve area (all p < 0.05). Among those with ES3 valves, the incidence of sPPM was inversely proportional to the valve size (50%, 25%, 5% and 3% for 20-, 23-, 26- and 29-mm valve sizes, respectively; p < 0.001). At a mean follow-up period of 3.5 ± 1.5 years, there was no difference in all-cause mortality (22.5% vs. 25.6%, p = 0.89) or a composite endpoint of heart failure, arrhythmias, stroke, and myocardial infarction (30% vs. 34%, p = 0.24) in those with or without sPPM. Conclusion ES3 was associated with a higher incidence of sPPM, particularly with smaller valve sizes. However, the presence of sPPM as defined by iEOA was not an independent predictor of adverse outcomes in patients undergoing TAVR within an intermediate follow-up period.
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Affiliation(s)
| | - Marsel Matka
- Cardiology, St. Luke's University Health Network, Bethlehem, USA
| | - Vivek Modi
- Cardiology, St. Luke's University Health Network, Bethlehem, USA
| | - Matthew Carey
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | | | - Raymond Durkin
- Interventional Cardiology, St. Luke's University Health Network, Bethlehem, USA
| | - Stephen Olenchock
- Cardiac Surgery, St. Luke's University Health Network, Bethlehem, USA
| | - Mehdi Razzaghi
- Statistics, Bloomsburg University of Pennsylvania, Bloomsburg, USA
| | - Jamshid Shirani
- Cardiology, St. Luke's University Health Network, Bethlehem, USA
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Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement in Asian Patients. Ann Thorac Surg 2021; 114:1612-1619. [PMID: 34678284 DOI: 10.1016/j.athoracsur.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about the incidence of prosthesis-patient mismatch (PPM) and its impact following transcatheter aortic valve replacement with self-expanding valves in Asian population. We aimed to assess post-procedural effective orifice area with standardized methods and the impact of PPM on mid-term outcomes after CoreValve/Evolut R implantation in Asian population. METHODS Among 201 consecutive patients undergoing CoreValve/Evolut R implantation, PPM was assessed at 30 days and defined based on core lab-measured indexed effective orifice area as severe (< 0.65 cm2/m2) or moderate (0.65 to 0.85 cm2/m2). Multivariable regression models were utilized to examine predictors of PPM as well as mortality and rehospitalization for heart failure at mid-term follow-up. RESULTS Moderate and severe PPM were observed following self-expanding valves in 37 (18.4%) and 3 (1.5%) patients, respectively. These 40 patients were included in the PPM group. Predictors of PPM included female, larger body surface area, and lower left ventricular ejection fraction. At mid-term (median 30.4 months, interquartile range 17.0 to 57.8 months) follow-up, patients with PPM had an increased risk of all-cause death (adjusted hazard ratio [aHR]: 1.95; 95% CI: 1.08 to 3.53; P = 0.027), cardiovascular mortality (aHR: 3.38; 95% CI: 1.04 to 10.99; P = 0.043), and rehospitalization for heart failure (aHR: 2.40; 95% CI: 1.11 to 5.17; P = 0.025). CONCLUSIONS PPM was associated with higher mid-term mortality and rehospitalization for heart failure in Asian population. The expected post-procedural effective orifice area for any given valve size may be helpful in pre-procedural decision-making to avoid PPM.
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Vriesendorp MD, De Lind Van Wijngaarden RAF, Head SJ, Kappetein AP, Hickey GL, Rao V, Weissman NJ, Reardon MJ, Moront MG, Sabik JF, Klautz RJM. The fallacy of indexed effective orifice area charts to predict prosthesis-patient mismatch after prosthesis implantation. Eur Heart J Cardiovasc Imaging 2021; 21:1116-1122. [PMID: 32243493 PMCID: PMC7971169 DOI: 10.1093/ehjci/jeaa044] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 12/02/2022] Open
Abstract
Aims Indexed effective orifice area (EOAi) charts are used to determine the likelihood of prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR). The aim of this study is to validate whether these EOAi charts, based on echocardiographic normal reference values, can accurately predict PPM. Methods and results In the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial, 986 patients with aortic valve stenosis/regurgitation underwent AVR with an Avalus valve. Patients were randomly split (50:50) into training and test sets. The mean measured EOAs for each valve size from the training set were used to create an Avalus EOAi chart. This chart was subsequently used to predict PPM in the test set and measures of diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) were assessed. PPM was defined by an EOAi ≤0.85 cm2/m2, and severe PPM was defined as EOAi ≤0.65 cm2/m2. The reference values obtained from the training set ranged from 1.27 cm2 for size 19 mm up to 1.81 cm2 for size 27 mm. The test set had an incidence of 66% of PPM and 24% of severe PPM. The EOAi chart inaccurately predicted PPM in 30% of patients and severe PPM in 22% of patients. For the prediction of PPM, the sensitivity was 87% and the specificity 37%. For the prediction of severe PPM, the sensitivity was 13% and the specificity 98%. Conclusion The use of echocardiographic normal reference values for EOAi charts to predict PPM is unreliable due to the large proportion of misclassifications.
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Affiliation(s)
- Michiel D Vriesendorp
- Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | | | - Stuart J Head
- Global Clinical Operations, Coronary and Structural Heart, Medtronic, Endepolsdomein 5, 6229 GW, Maastricht, Netherlands
| | - Arie-Pieter Kappetein
- Global Clinical Operations, Coronary and Structural Heart, Medtronic, Endepolsdomein 5, 6229 GW, Maastricht, Netherlands
| | - Graeme L Hickey
- Global Clinical Operations, Coronary and Structural Heart, Medtronic, Endepolsdomein 5, 6229 GW, Maastricht, Netherlands
| | - Vivek Rao
- Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada
| | - Neil J Weissman
- Cardiovascular Core Laboratories, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD 20782, USA
| | - Michael J Reardon
- Cardiovascular Surgery, Houston Methodist Debakey Heart and Vascular Center, 6550 Fannin Street, Houston, TX 77030, USA
| | - Michael G Moront
- Cardiothoracic Surgery, ProMedica Toledo Hospital, 2109 Hughes Drive, Suite 720, Toledo, OH 43606, USA
| | - Joseph F Sabik
- Cardiac Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH 44106-7060, USA
| | - Robert J M Klautz
- Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
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Leone PP, Fazzari F, Cannata F, Sanz-Sanchez J, Mangieri A, Monti L, Cozzi O, Stefanini GG, Bragato R, Colombo A, Reimers B, Regazzoli D. Clinical and Technical Challenges of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:670457. [PMID: 34150868 PMCID: PMC8211887 DOI: 10.3389/fcvm.2021.670457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Jorge Sanz-Sanchez
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
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Kim HJ, Kim HJ, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Prosthesis-patient mismatch after surgical aortic valve replacement in patients with aortic stenosis. Interact Cardiovasc Thorac Surg 2021; 31:152-157. [PMID: 32594112 DOI: 10.1093/icvts/ivaa085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The issue of prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) has been a controversial topic. We sought to evaluate the long-term clinical impacts of PPM in patients undergoing SAVR in an updated, homogeneous cohort. METHODS Using the prospective institutional database, we identified 895 adult patients (median age 66, interquartile range 58-72; 45.6% women) who underwent isolated SAVR from January 2000 to March 2016. Those with pure aortic insufficiency and concomitant other cardiac operations were excluded from this study cohort. The presence of a significant PPM was defined as an indexed effective orifice area 0.85 cm2/m2 or less. The outcome of interest was all-cause deaths. Propensity score matching was performed for adjusting bias. RESULTS Significant PPM was present in 247 patients (27.6%). During the follow-up period (mean 71.2 ± 51.04 months), 134 patients (15%) died. Survival rates at 10 and 15 years were 78.3% vs 83.8% and 71.3% vs 57.6% in the PPM and non-PPM groups (P = 0.972). Risk factor analysis indicated that developing PPM was not associated with a risk of death. After propensity score matching (1:1), developing PPM was not a risk factor for long-term death as well (P = 0.584). CONCLUSIONS Significant PPM was common after SAVR in patients with aortic stenosis. However, there was no significant difference in survival rate between those with and without PPM.
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Affiliation(s)
- Hee Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University, Seoul, Korea
| | - Ho Jin Kim
- 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
| | - 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
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Luthra S, Malvindi PG, Olevano C, Zingale A, Salem H, Ohri SK. Impact of valve size, predicted effective and indexed effective orifice area after aortic valve replacement. J Card Surg 2021; 36:961-968. [PMID: 33428257 DOI: 10.1111/jocs.15311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The impact of manufacturer labeled prosthesis size and predicted effective orifice area (EOA) on long-term survival after aortic valve replacement is not clear although indexed effective orifice area (iEOA) has been associated with worse survival. METHODS Data was retrospectively collected from Jan 2000-Dec 2019 for prosthesis type, model, and size for isolated aortic valve replacements. Stratified survival was compared between groups and subgroups for labeled valve size, EOA and predicted patient prosthesis mismatch (PPM). RESULTS A total of 3444 patients were included. Moderate and severe PPM was 15.6% and 1.6%, respectively. Cumulative lifetime hazard was worse for biological valves (mortality: biological 77.7% vs. mechanical 64.8%, p = .001). Moderate prosthetic aortic stenosis (AS), (EOA = 1-1.5 cm2 ) was 12.1% and severe prosthetic AS (EOA ≤ 1 cm2 ) was 0.8%, respectively. Survival was 10.5 ± 0.4 years with moderate to severe prosthetic AS (EOA≤1.5 cm2 ) versus 12.6 ± 0.2 years with mild to no prosthetic AS (EOA>1.5 cm2 ), p = .001. Worse survival in the presence of moderate-severe prosthetic AS was seen with biological valves (9.7 ± 0.4 years vs. 11.2 ± 0.2 years, p = .001 for EOA≤1.5, >1.5 cm2 , respectively). Moderate to severe PPM was associated with worse survival (11.1 ± 0.4 years for iEOA ≤ 0.85 cm2 /m2 vs. 12.5 ± 0.2 years with iEOA > 0.85 cm2 /m2 , p = .001). Moderate to severe PPM predicted worse long term survival (hazard ratio: 3.56; 95% confidence interval: 1.37-9.25; p = .009). CONCLUSION Predicted prosthetic moderate to severe AS and moderate to severe PPM adversely affect long term survival. Smaller valves are associated with reduced survival.
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Affiliation(s)
- Suvitesh Luthra
- Institution - Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Pietro G Malvindi
- Institution - Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Carlo Olevano
- Institution - Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Anna Zingale
- Institution - Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Hamdi Salem
- Institution - Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - Sunil K Ohri
- Institution - Wessex Cardiothoracic Centre, Division of Cardiac Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
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Hernandez-Vaquero D, Vigil-Escalera C, Persia Y, Morales C, Pascual I, Domínguez-Rodríguez A, Rodríguez-Caulo E, Carnero M, Díaz R, Avanzas P, Moris C, Silva J. Perceval or Trifecta to Prevent Patient-Prosthesis Mismatch. J Clin Med 2020; 9:jcm9092964. [PMID: 32937912 PMCID: PMC7563879 DOI: 10.3390/jcm9092964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022] Open
Abstract
The Trifecta aortic valve has excellent hemodynamics characteristics. Moreover, the Perceval prosthesis may achieve better hemodynamics than the conventional valves; therefore, it has been proposed to reduce the incidence of patient-prosthesis mismatch. Our aim was to compare the prevalence of this complication between both prostheses. All patients who underwent valve replacement with a Perceval or a Trifecta from 2016 to 2020 at our institution were included. We calculated the prevalence of patient-prosthesis mismatch for each prosthesis and size and performed a multinomial logistic regression model to investigate the impact of choosing one prosthesis over the other. A total of 516 patients were analyzed. Moderate mismatch was present in 33 (8.6%) in the Trifecta group and 28 (21.4%) in the Perceval group, p < 0.001. Severe mismatch was present in 8 (2.1%) patients with Trifecta and 5 (3.8%) patients with Perceval, p = 0.33. Compared with the Perceval, the Trifecta prosthesis was shown to reduce moderate patient-prosthesis mismatch: OR = 0.5 (95% CI 0.3-0.9, p = 0.02). Both prostheses led to a similar risk of severe patient-prosthesis mismatch: OR = 0.9 (95% CI 0.3-2.8, p = 0.79). Both prostheses provide a very low risk of severe patient-prosthesis mismatch. Compared with the Perceval prothesis, the Trifecta prosthesis is able to reduce by 50% the risk of moderate mismatch.
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Affiliation(s)
- Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
- Correspondence: ; Tel.: +34-985274688
| | - Carlota Vigil-Escalera
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Yvan Persia
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Carlos Morales
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Isaac Pascual
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | | | | | - Manuel Carnero
- Cardiac Surgery Department, Hospital Universitario Clinico San Carlos, 28040 Madrid, Spain;
| | - Rocío Díaz
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Pablo Avanzas
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Cesar Moris
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Jacobo Silva
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
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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: 73] [Impact Index Per Article: 18.3] [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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Herrmann HC. Prosthesis–Patient Mismatch After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2183-2185. [DOI: 10.1016/j.jcin.2019.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 11/27/2022]
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Otto ME, Atik FA, Moreira MDN, Ribeiro LCM, Mello BCRD, Lima JGE, Ribeiro MS, Domingues ACPM, Calzada RP, Jreige A, Schloicka LL, Pibarot P. Determinants of Aortic Prosthesis Mismatch in a Brazilian Public Health System Hospital: Big Patients or Small Prosthesis? Arq Bras Cardiol 2019; 114:12-22. [PMID: 31664320 PMCID: PMC7025311 DOI: 10.5935/abc.20190231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/10/2019] [Indexed: 11/25/2022] Open
Abstract
Background Prosthesis-patient mismatch (PPM) is associated with worse outcomes. Objective Determine the frequency and evaluate preoperatory variables independently associated with severe PPM in a tertiary hospital focused on Public Health Care. Methods A total of 316 patients submitted to aortic valve replacement, who had echocardiography performed within the first 30 days after surgery, were retrospectively analyzed. The indexed effective orifice area (iEOA) of the prosthesis was used to classify the patients into three groups, according to PPM, considering body mass index (BMI): severe PPM (iEOA) < 0.65 cm2/m2), mild to moderate PPM (iEOA, 0.65 cm2/m2 - 0.85 cm2/m2) and without PPM (iEOA > 0.85 cm2/m2) for a BMI < 30 kg/m2 and severe PPM (iEOA) < 0.55 cm2/m2), mild to moderate (iEOA, 0.55 cm2/m2- 0.70 cm2/m2) and without PPM (iEOA > 0.7 cm2/m2) for a BMI > 30 kg/m2. Statistical significance was considered when p < 0.05. Results iEOA was obtained in 176 patients. The frequency of severe and moderate PPM was 33.4% and 36.2%, respectively. Severe PPM patients were younger and had larger BMI, but smaller left ventricular outflow tract diameter (LVOTD). The independent variables used to predict severe PPM were male gender, BMI > 25 kg/m2, age < 60 years, LVOTD < 21 mm, and rheumatic etiology with an area under the ROC curve of 0.82. Conclusion The frequency of severe PPM is high in a Brazilian population representative of the Public Health System, and it is possible to predict PPM from preoperative variables such as rheumatic valvular disease, gender, BMI, age and LVOTD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Armindo Jreige
- Instituto de Cardiologia do Distrito Federal (ICDF), Brasília, DF - Brazil
| | | | - Philippe Pibarot
- Québec Heart & Lung Institute - Valvular Heart Diseases, Quebec - Canada
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Rajiah P, Moore A, Saboo S, Goerne H, Ranganath P, MacNamara J, Joshi P, Abbara S. Multimodality Imaging of Complications of Cardiac Valve Surgeries. Radiographics 2019; 39:932-956. [PMID: 31150303 DOI: 10.1148/rg.2019180177] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Replacement with a prosthetic heart valve (PHV) remains the definitive surgical procedure for management of severe cardiac valve disease. PHV dysfunction is uncommon but can be a life-threatening condition. The broad hemodynamic and pathophysiologic manifestations of PHV dysfunction are stenosis, regurgitation, and a stuck leaflet. Specific structural abnormalities that cause PHV dysfunction include prosthetic valve-patient mismatch, structural failure, valve calcification, dehiscence, paravalvular leak, infective endocarditis, abscess, pseudoaneurysm, abnormal connections, thrombus, hypoattenuating leaflet thickening, and pannus. Multiple imaging modalities are available for evaluating a PHV and its dysfunction. Transthoracic echocardiography is often the first-line imaging modality, with additional modalities such as transesophageal echocardiography, CT, MRI, cine fluoroscopy, and nuclear medicine used for further characterization and establishing a specific cause. The authors review PHVs and the role of imaging modalities in evaluation of PHV dysfunction and illustrate the imaging appearances of different complications. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Alastair Moore
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Sachin Saboo
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - James MacNamara
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Parag Joshi
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
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Herrmann HC, Daneshvar SA, Fonarow GC, Stebbins A, Vemulapalli S, Desai ND, Malenka DJ, Thourani VH, Rymer J, Kosinski AS. Prosthesis–Patient Mismatch in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2018; 72:2701-2711. [DOI: 10.1016/j.jacc.2018.09.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2018; 72:2712-2716. [DOI: 10.1016/j.jacc.2018.09.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 11/20/2022]
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Abdelghani M, Allali A, Kaur J, Hemetsberger R, Mehilli J, Neumann F, Frerker C, Kurz T, El‐Mawardy M, Richardt G, Abdel‐Wahab M. Impact of prosthesis‐iteration evolution and sizing practice on the incidence of prosthesis–patient mismatch after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:971-979. [DOI: 10.1002/ccd.27977] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/15/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Mohammad Abdelghani
- The Heart Center, Segeberger Kliniken Bad Segeberg Germany
- Cardiology Department, The Academic Medical CenterUniversity of Amsterdam Amsterdam The Netherlands
| | | | | | | | - Julinda Mehilli
- Munich University CenterLudwig‐Maximilians University Munich Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich Germany
| | | | | | - Thomas Kurz
- Cardiology DepartmentLübeck University Hospital Lübeck Germany
| | | | - Gert Richardt
- The Heart Center, Segeberger Kliniken Bad Segeberg Germany
| | - Mohamed Abdel‐Wahab
- The Heart Center, Segeberger Kliniken Bad Segeberg Germany
- Cardiology DepartmentHeart Center Leipzig, University Hospital Leipzig Germany
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Fallon JM, Pibarot P. Reply. Ann Thorac Surg 2018; 107:324-325. [PMID: 30342047 DOI: 10.1016/j.athoracsur.2018.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- John M Fallon
- Department of Cardiothoracic Surgery, Emory University, 1365 Clifton Rd NE, Bldg A, Ste A2202, Atlanta, GA 30322.
| | - Philippe Pibarot
- Department of Medicine, Québec Heart & Lung Institute, University of Laval, Québec City, Québec, Canada
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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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22
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Chambers J. Replacement Heart Valves. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Reply. Ann Thorac Surg 2017; 106:315-316. [PMID: 29253465 DOI: 10.1016/j.athoracsur.2017.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/22/2022]
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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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Salna M, Khalique OK, Chiuzan C, Kurlansky P, Borger MA, Hahn RT, Leon MB, Smith CR, Kodali SK, George I. Impact of small prosthesis size on transcatheter or surgical aortic valve replacement outcomes. Catheter Cardiovasc Interv 2017; 91:765-773. [DOI: 10.1002/ccd.27120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Michael Salna
- Division of Cardiothoracic Surgery; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
| | - Omar K. Khalique
- Division of Cardiology; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
| | - Codruta Chiuzan
- Department of Biostatistics; Mailman School of Public Health, Columbia University; New York
| | - Paul Kurlansky
- Division of Cardiothoracic Surgery; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
| | - Michael A. Borger
- Division of Cardiothoracic Surgery; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
| | - Rebecca T. Hahn
- Division of Cardiology; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
| | - Martin B. Leon
- Division of Cardiology; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
| | - Craig R. Smith
- Division of Cardiothoracic Surgery; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
| | - Susheel K. Kodali
- Division of Cardiology; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
| | - Isaac George
- Division of Cardiothoracic Surgery; New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University; New York
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017; 30:101-138. [DOI: 10.1016/j.echo.2016.10.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1191-1229. [DOI: 10.1093/ehjci/jew190] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022] Open
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Joshi SS, Ashwini T, George A, Jagadeesh AM. Patient prosthesis mismatch after aortic valve replacement: An Indian perspective. Ann Card Anaesth 2016; 19:84-8. [PMID: 26750679 PMCID: PMC4900404 DOI: 10.4103/0971-9784.173025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
CONTEXT Perioperative period. AIMS Occurrence of PPM after AVR, factors associated with PPM, impact on mortality. SETTINGS AND DESIGN Teritary Care Referral Cardiac Centre. MATERIALS AND METHODS A retrospective analysis of AVR procedures at a single centre over 4 years was conducted. Demographic, echocardiographic and outcome data were collected from institute database. Rahimtoola criteria of indexed effective orifice area (iEOA) were used to stratify patients into PPM categories. Patients with and without PPM were compared for associated factors. STATISTICAL ANALYSIS USED Independent t-test, chi-square test, logistic regression analysis, ROC-AUC, Youden index. RESULTS 606 patients with complete data were analysed for PPM. The incidence of mild, moderate and severe PPM was 6.1% (37), 2.5% (15) and 0.5% (3) respectively. There was no impact of PPM on all-cause in-hospital mortality. PPM was observed more with Aortic Stenosis (AS) compared to Aortic Regurgitation (AR) as etiology. Aortic annulus indexed to BSA (iAA) had a very good predictive ability for PPM at <16mm/m 2 BSA. CONCLUSIONS PPM has lower incidence after AVR in this Indian population and does not increase early mortality. Patients with AS and iAA<16mm/m2BSA should be cautiously dealt with to prevent PPM.
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Affiliation(s)
- Shreedhar S Joshi
- Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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Sportelli E, Regesta T, Salsano A, Ghione P, Brega C, Bezante GP, Passerone G, Santini F. Does patient-prosthesis mismatch after aortic valve replacement affect survival and quality of life in elderly patients? J Cardiovasc Med (Hagerstown) 2016; 17:137-43. [PMID: 26237424 DOI: 10.2459/jcm.0000000000000292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND To evaluate the impact of patient-prosthesis mismatch (PPM) on survival, functional status, and quality of life (QoL) after aortic valve replacement (AVR) with small prosthesis size in elderly patients. METHODS Between January 2005 and December 2013, 152 patients with pure aortic stenosis, aged at least 75 years, underwent AVR, with a 19 or 21 mm prosthetic heart valve. PPM was defined as an indexed effective orifice area less than 0.85 cm/m. Median age was 82 years (range 75-93 years). Mean follow-up was 56 months (range 1-82 months) and was 98% complete. Late survival rate, New York Heart Association functional class, and QoL (RAND SF-36) were assessed. RESULTS Overall, PPM was found in 78 patients (53.8%). Among them, 42 patients (29%) had an indexed effective orifice area less than 0.75 cm/m and 17 less than 0.65 cm/m (11.7%). Overall survival at 5 years was 78 ± 4.5% and was not influenced by PPM (P = NS). The mean New York Heart Association class for long-term survivors with PPM improved from 3.0 to 1.7 (P < 0.001). QoL (physical functioning 45.18 ± 11.35, energy/fatigue 49.36 ± 8.64, emotional well being 58.84 ± 15.44, social functioning 61.29 ± 6.15) was similar to that of no-PPM patients (P = NS). CONCLUSION PPM after AVR does not affect survival, functional status, and QoL in patients aged at least 75 years. Surgical procedures, often time-consuming, contemplated to prevent PPM, may therefore be not justified in this patient subgroup.
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Affiliation(s)
- Elena Sportelli
- aDivision of Cardiac Surgery bDivision of Cardiology, IRCCS San Martino-IST, University of Genova Medical School, Genova, Italy
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Pibarot P, Clavel MA, Dahou A. Patient and procedure selection for the prevention of prosthesis-patient mismatch following aortic valve replacement. EUROINTERVENTION 2016; 11 Suppl W:W106-9. [PMID: 26384172 DOI: 10.4244/eijv11swa31] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Prosthesis-patient mismatch (PPM) is frequent following surgical aortic valve replacement (SAVR) and is associated with an increased risk of morbidity and mortality. Preventive strategies to avoid or minimise PPM should be implemented in patients who are at high risk (i.e., patients with a small aortic annulus or those undergoing a valve-in-valve procedure within a small surgical bioprosthesis) and/or vulnerable to PPM (i.e., depressed left ventricular [LV] systolic function, severe LV hypertrophy, concomitant mitral regurgitation, and paradoxical low-flow, low-gradient aortic stenosis). Recent studies suggest that transcatheter aortic valve replacement (TAVR) may be superior to SAVR for the prevention of PPM and associated adverse cardiac events, particularly in the subset of patients with a small (<21 mm) aortic annulus. However, further randomised studies are needed to confirm the potential superiority of TAVR for this purpose.
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Affiliation(s)
- Philippe Pibarot
- Quebec Heart & Lung Institute, Department of Medicine, Laval University, Quebec, Canada
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Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement: Multicenter Registry. J Am Coll Cardiol 2016; 67:644-655. [PMID: 26868689 DOI: 10.1016/j.jacc.2015.10.097] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/21/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Scarce data exist on the incidence of and factors associated with valve hemodynamic deterioration (VHD) after transcatheter aortic valve replacement (TAVR). OBJECTIVES This study sought to determine the incidence, timing, and predictors of VHD in a large cohort of patients undergoing TAVR. METHODS This multicenter registry included 1,521 patients (48% male; 80 ± 7 years of age) who underwent TAVR. Mean echocardiographic follow-up was 20 ± 13 months (minimum: 6 months). Echocardiographic examinations were performed at discharge, at 6 to 12 months, and yearly thereafter. Annualized changes in mean gradient (mm Hg/year) were calculated by dividing the difference between the mean gradient at last follow-up and the gradient at discharge by the time between examinations. VHD was defined as a ≥10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessment. RESULTS The overall mean annualized rate of transprosthetic gradient progression during follow-up was 0.30 ± 4.99 mm Hg/year. A total of 68 patients met criteria of VHD (incidence: 4.5% during follow-up). The absence of anticoagulation therapy at hospital discharge (p = 0.002), a valve-in-valve (TAVR in a surgical valve) procedure (p = 0.032), the use of a 23-mm valve (p = 0.016), and a greater body mass index (p = 0.001) were independent predictors of VHD. CONCLUSIONS There was a mild but significant increase in transvalvular gradients over time after TAVR. The lack of anticoagulation therapy, a valve-in-valve procedure, a greater body mass index, and the use of a 23-mm transcatheter valve were associated with higher rates of VHD post-TAVR. Further prospective studies are required to determine whether a specific antithrombotic therapy post-TAVR may reduce the risk of VHD.
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Swinkels BM, de Mol BA, Kelder JC, Vermeulen FE, ten Berg JM. Prosthesis–Patient Mismatch After Aortic Valve Replacement: Effect on Long-Term Survival. Ann Thorac Surg 2016; 101:1388-94. [DOI: 10.1016/j.athoracsur.2016.01.048] [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: 09/18/2015] [Revised: 01/02/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Utsunomiya H, Mihara H, Itabashi Y, Kobayashi S, Siegel RJ, Chakravarty T, Jilaihawi H, Makkar RR, Shiota T. Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis-patient mismatch: an intraprocedural 3D-TEE study. Eur Heart J Cardiovasc Imaging 2016; 18:1-10. [PMID: 27025512 DOI: 10.1093/ehjci/jew039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/13/2016] [Indexed: 11/14/2022] Open
Abstract
AIMS Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus (AoA) and left ventricular outflow tract (LVOT) during TAVR by three-dimensional transoesophageal echocardiography (3D-TEE) and its association with post-procedural PPM. METHODS AND RESULTS A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVR. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as ≥0.65 and ≤0.85 cm2/m2 and severe defined as <0.65 cm2/m2. 3D planimetered AoA area decreased after TAVR (P< 0.001), whereas the LVOT increased (P= 0.004). The eccentricity of both AoA and LVOT decreased after TAVR (both, P< 0.001). At discharge, the incidence of overall and severe PPM was 44 and 12%, respectively. Patients with PPM had a larger body surface area, smaller aortic valve area, and less frequent balloon dilation (all P< 0.05). Patients with PPM had a lower post-TAVR AoA area/pre-TAVR AoA area (91 ± 8 vs. 95 ± 7%, P= 0.001) than those without PPM. The post-TAVR AoA area/pre-TAVR AoA area was independently associated with overall PPM (odds ratio, 1.80; 95% CI, 1.06-3.05; P= 0.031) and severe PPM (odds ratio, 2.50; 95% CI, 1.05-5.36; P= 0.04). Additionally, a cut-off value of this ratio >86.3% had a sensitivity of 84% and a specificity of 44% for the prevention of severe PPM. CONCLUSION 3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVR and predicts post-procedural PPM.
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Affiliation(s)
- Hiroto Utsunomiya
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Hirotsugu Mihara
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Yuji Itabashi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Sayuki Kobayashi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.,University of California, Los Angeles, CA, USA
| | - Tarun Chakravarty
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Hasan Jilaihawi
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA
| | - Takahiro Shiota
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA .,University of California, Los Angeles, CA, USA
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Bach DS, Patel HJ, Kolias TJ, Deeb GM. Randomized comparison of exercise haemodynamics of Freestyle, Magna Ease and Trifecta bioprostheses after aortic valve replacement for severe aortic stenosis. Eur J Cardiothorac Surg 2016; 50:361-7. [DOI: 10.1093/ejcts/ezv493] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/22/2015] [Indexed: 11/13/2022] Open
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Frank M, Ganzoni G, Starck C, Grünenfelder J, Corti R, Gruner C, Hürlimann D, Tanner FC, Jenni R, Greutmann M, Biaggi P. Lack of Accessible Data on Prosthetic Heart Valves. Int J Cardiovasc Imaging 2015; 32:439-47. [DOI: 10.1007/s10554-015-0805-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
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van Slooten YJ, van Melle JP, Freling HG, Bouma BJ, van Dijk AP, Jongbloed MR, Post MC, Sieswerda GT, Huis In 't Veld A, Ebels T, Voors AA, Pieper PG. Aortic valve prosthesis-patient mismatch and exercise capacity in adult patients with congenital heart disease. Heart 2015; 102:107-13. [PMID: 26596791 DOI: 10.1136/heartjnl-2015-308013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/19/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To report the prevalence of aortic valve prosthesis-patient mismatch (PPM) in an adult population with congenital heart disease (CHD) and its impact on exercise capacity. Adults with congenital heart disease (ACHD) with a history of aortic valve replacement may outgrow their prosthesis later in life. However, the prevalence and clinical consequences of aortic PPM in ACHD are presently unknown. METHODS From the national Dutch Congenital Corvitia (CONCOR) registry, we identified 207 ACHD with an aortic valve prosthesis for this cross-sectional cohort study. Severe PPM was defined as an indexed effective orifice area ≤0.65 cm2/m2 and moderate PPM as an indexed orifice area ≤0.85 cm2/m2 measured using echocardiography. Exercise capacity was reported as percentage of predicted exercise capacity (PPEC). RESULTS Of the 207 patients, 68% was male, 71% had a mechanical prosthesis and mean age at inclusion was 43.9 years ±11.4. The prevalence of PPM was 42%, comprising 23% severe PPM and 19% moderate PPM. Prevalence of PPM was higher in patients with mechanical prostheses (p<0.001). PPM was associated with poorer exercise capacity (mean PPEC 84% vs. 92%; p=0.048, mean difference =-8.3%, p=0.047). Mean follow-up was 2.6±1.1 years during which New York Heart Association (NYHA) class remained stable in most patients. PPM showed no significant effect on death or hospitalisation during follow-up (p=0.218). CONCLUSIONS In this study we report a high prevalence (42%) of PPM in ACHD with an aortic valve prosthesis and an independent association of PPM with diminished exercise capacity.
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Affiliation(s)
- Ymkje J van Slooten
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Department of Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendrik G Freling
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Arie Pj van Dijk
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique Rm Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Gertjan T Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anna Huis In 't Veld
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tjark Ebels
- Department of Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Petronella G Pieper
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Chambers J, Ray S, Prendergast B, Graham T, Campbell B, Greenhalgh D, Petrou M, Tinkler J, Gohlke-Bärwolf C, Mestres CA, Rosenhek R, Pibarot P, Otto C, Sundt T. Standards for heart valve surgery in a 'Heart Valve Centre of Excellence'. Open Heart 2015; 2:e000216. [PMID: 26180639 PMCID: PMC4499687 DOI: 10.1136/openhrt-2014-000216] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/22/2015] [Accepted: 04/10/2015] [Indexed: 12/15/2022] Open
Abstract
Surgical centres of excellence should include multidisciplinary teams with specialist expertise in imaging, clinical assessment and surgery for patients with heart valve disease. There should be structured training programmes for the staff involved in the periprocedural care of the patient and these should be overseen by national or international professional societies. Good results are usually associated with high individual and centre volumes, but this relationship is complex. Results of surgery should be published by centre and should include rates of residual regurgitation for mitral repairs and reoperation rates matched to the preoperative pathology and risk.
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Affiliation(s)
| | | | | | - Tim Graham
- Society of Cardiothoracic Surgeons of Great Britain and Ireland , UK
| | | | - Donna Greenhalgh
- Department of Cardiac Anaesthesia , Wythenshawe Hospital , Manchester , UK
| | | | | | | | - Carlos A Mestres
- Department of Cardiovascular Surgery , Hospital Clinico, University of Barcelona , Spain
| | | | | | - Catherine Otto
- Division of Cardiology , University of Washington , Seattle, Washington , USA
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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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Rodés-Cabau J, Pibarot P, Suri RM, Kodali S, Thourani VH, Szeto WY, Svensson LG, Dumont E, Xu K, Hahn RT, Leon MB. Impact of Aortic Annulus Size on Valve Hemodynamics and Clinical Outcomes After Transcatheter and Surgical Aortic Valve Replacement. Circ Cardiovasc Interv 2014; 7:701-11. [DOI: 10.1161/circinterventions.114.001681] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Josep Rodés-Cabau
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Philippe Pibarot
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Rakesh M. Suri
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Susheel Kodali
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Vinod H. Thourani
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Wilson Y. Szeto
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Lars G. Svensson
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Eric Dumont
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Ke Xu
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Rebecca T. Hahn
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
| | - Martin B. Leon
- From the Quebec Heart and Lung Institute, Quebec City, Quebec, Canada (J.-R.C., P.P., E.D.); Mayo Clinic, Rochester, MN (R.M.S.); Columbia University Medical Center/NewYork Presbyterian Hospital (S.K., R.T.H., M.B.L.); Emory University School of Medicine, Atlanta, GA (V.H.T.); Hospital of the University of Pennsylvania, Philadelphia (W.Y.S.); Cleveland Clinic, OH (L.G.S.); and Cardiovascular Research Foundation, New York, NY (K.X.)
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Hu J, Qian H, Li YJ, Gu J, Zhao JJ, Zhang EY. Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter? J Cardiothorac Surg 2014; 9:17. [PMID: 24438101 PMCID: PMC3896805 DOI: 10.1186/1749-8090-9-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/02/2014] [Indexed: 02/05/2023] Open
Abstract
Background The study was designed to evaluate the effects of moderate prosthesis-patient mismatch (defined as 0.65 cm2/m2 < indexed effective orifice area ≤ 0.85 cm2/m2) on midterm outcomes after isolated aortic valve replacement with a 17-mm St. Jude Medical Regent valve in a large series of patients, and to determine if these effects are influenced by patient confounding variables. Methods One-hundred and six patients with and without moderate prosthesis-patient mismatch early after implantation of a 17-mm Regent valve at aortic position were included. Both clinical and echocardiographic assessments were performed preoperatively, at discharge and during follow-up period (mean follow-up time 52.6 ± 11.9 months). Results The prevalence of moderate prosthesis-patient mismatch was documented in 46 patients (43.4%) at discharge. During the follow-up period, no difference in the regression of left ventricular mass, decrease of transvalvular pressure gradients, mortality and prosthesis-related complications was observed between patients with and without moderate prosthesis-patient mismatch. After adjustment for several risk factors, moderate prosthesis-patient mismatch was associated with increased midterm mortality in patients with baseline left ventricular ejection fraction < 50% (HR: 1.80, p = 0.02), but with normal prognosis in those with preserved LV function. Younger age (cut off value = 65 years) was not an independent predictor of increased midterm mortality and valve-related complications in patients with moderate prosthesis-patient mismatch. Conclusions Moderate prosthesis-patient mismatch after aortic valve replacement with a small mechanical prosthesis is associated with increased mortality and adverse events in patients with pre-existing left ventricular dysfunction. Selected patients with small aortic annulus can experience satisfactory clinical improvements and midterm survival after aortic valve replacement with a 17-mm Regent valve.
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Affiliation(s)
| | | | | | | | | | - Er-yong Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Hernandez-Vaquero D, Garcia JM, Diaz R, Calvo D, Khalpey Z, Hernández E, Rodriguez V, Morís C, Llosa JC. Moderate Patient-Prosthesis Mismatch Predicts Cardiac Events and Advanced Functional Class in Young and Middle-Aged Patients Undergoing Surgery Due to Severe Aortic Stenosis. J Card Surg 2013; 29:127-33. [DOI: 10.1111/jocs.12265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Jose M. Garcia
- Department of Cardiology; Central Universitary Hospital of Asturias; Oviedo Spain
| | - Rocio Diaz
- Department of Cardiac Surgery; Central Universitary Hospital of Asturias; Oviedo Spain
| | - David Calvo
- Department of Cardiology; Central Universitary Hospital of Asturias; Oviedo Spain
| | - Zain Khalpey
- Department of Cardiac Surgery, College of Medicine; University of Arizona; Tucson Arizona
| | | | | | - César Morís
- Department of Cardiology; Central Universitary Hospital of Asturias; Oviedo Spain
| | - Juan C. Llosa
- Department of Cardiac Surgery; Central Universitary Hospital of Asturias; Oviedo Spain
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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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Finkelstein A, Schwartz AL, Uretzky G, Banai S, Keren G, Kramer A, Topilsky Y. Hemodynamic performance and outcome of percutaneous versus surgical stentless bioprostheses for aortic stenosis with anticipated patient-prosthesis mismatch. J Thorac Cardiovasc Surg 2013; 147:1892-9. [PMID: 23993320 DOI: 10.1016/j.jtcvs.2013.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/19/2013] [Accepted: 07/09/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to compare the performance and midterm survival of transcutaneous aortic valve replacement (TAVR) and surgically implanted stentless aortic valve replacement (SAVR) for severe aortic stenosis in patients anticipated to have patient-prosthesis mismatch (PPM). METHODS A retrospective analysis was performed of 86 and 49 consecutive TAVR and SAVR patients with severe aortic stenosis and calculated minimal effective orifice area larger than the best projected effective orifice area. Cox hazard analyses were used to assess the effect of TAVR versus SAVR on outcome. RESULTS The peak and mean transprosthetic gradient at discharge were lower (P < .001 for both) in the TAVR group. Mild or greater aortic regurgitation was more frequent in the TAVR group (61% vs 7%; P < .0001). At 3 months of follow-up, the mean gradient in the TAVR group was similar to that of the SAVR group but the prevalence of aortic regurgitation was still higher. The unadjusted 3-year survival rate was superior in the SAVR versus TAVR group (91.6% ± 4% vs 67.0% ± 7%; P = .01). Adjustments for both age and comorbidity resulted in loss of the difference in mortality between the 2 groups. CONCLUSIONS In patients with anticipated PPM, TAVR offers an immediate lower incidence of PPM than SAVR but a greater prevalence of aortic regurgitation. The differences in transaortic gradients became nonsignificant 3 months postoperatively. The question of whether TAVR is a suitable substitute for SAVR in patients with anticipated PPM, in particular, those who are older and sicker, warrants additional investigation.
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Affiliation(s)
- Arie Finkelstein
- Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Arie Lorin Schwartz
- Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Gideon Uretzky
- Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Shmuel Banai
- Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Gad Keren
- Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Amir Kramer
- Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel-Aviv, Israel
| | - Yan Topilsky
- Division of Cardiovascular Diseases, Tel Aviv Medical Center, Tel-Aviv, Israel.
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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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Rahimtoola SH. The year in valvular heart disease. J Am Coll Cardiol 2013; 61:1290-1301. [PMID: 23500330 DOI: 10.1016/j.jacc.2012.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 11/28/2012] [Accepted: 12/04/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Shahbudin H Rahimtoola
- Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, Keck School of Medicine at University of Southern California, Los Angeles, CA 90033, USA.
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