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Ayyad M, Jabri A, Khalefa BB, Al-Abdouh A, Madanat L, Albandak M, Alhuneafat L, Sukhon F, Shahrori Z, Mourid MR, Mhanna M, Giustino G, Wang DD, Hanson ID, Abbas AE, AlQarqaz M, Villablanca P. Efficacy and safety of TAVR versus SAVR in patients with small aortic annuli: A systematic review and meta-analysis. Int J Cardiol 2024; 411:132243. [PMID: 38851542 DOI: 10.1016/j.ijcard.2024.132243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/05/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Patients with a small aortic annulus (SAA) undergoing aortic valve replacement are at increased risk of patient-prosthesis mismatch (PPM), which adversely affects outcomes. Transcatheter aortic valve replacement (TAVR) has shown promise in mitigating PPM compared to surgical aortic valve replacement (SAVR). METHODS We conducted a systematic review and meta-analysis following PRISMA guidelines to compare clinical outcomes, mortality, and PPM between SAA patients undergoing TAVR and SAVR. Eligible studies were identified through comprehensive literature searches and assessed for quality and relevance. RESULTS Nine studies with a total of 2476 patients were included. There was no significant difference in 30-day Mortality between TAVR vs SAVR groups (OR = 0.65, 95% CI [ 0.09-4.61], P = 0.22). There was no difference between both groups regarding myocardial infarction at 30 days (OR = 0.63, 95% CI [0.1-3.89], P = 0.62). TAVR was associated with a significantly lower 30-day major bleeding and 2-year major bleeding, Pooled studies were homogeneous (OR = 0.44, 95% CI [0.31-0.64], P < 0.01, I2 = 0, P = 0.89), (OR = 0.4 ,95% CI [0.21-0.77], P = 0.03, I2 = 0%, P = 0.62) respectively. TAVR was associated with a lower rate of moderate PPM (OR = 0.6, 95% CI [ 0.44-0.84], p value = 0.01, i2 = 0%, p value = 0.44). The overall effect estimate did not favor any of the two groups regarding short-term Mild AR (OR = 5.44, 95% CI [1.02-28.91], P = 0.05) and Moderate/severe AR (OR = 4.08, 95% CI [ 0.79-21.02], P = 0.08, I2 = 0%, P = 0.59). CONCLUSION Our findings suggest that both TAVR and SAVR are viable options for treating AS in patients with a small aortic annulus. TAVR offers advantages in reducing PPM and major bleeding, while SAVR performs better in terms of pacemaker implantation. Future studies should focus on comparing newer generation TAVR techniques and devices with SAVR. Consideration of patient characteristics is crucial in selecting the optimal treatment approach for AS.
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Affiliation(s)
- Mohammed Ayyad
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ahmad Jabri
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; Michigan State University, College of Human Medicine, USA
| | | | - Ahmad Al-Abdouh
- Division of hospital medicine, University of Kentucky, Lexington, KY, USA
| | - Luai Madanat
- Department of Cardiovascular Medicine, William Beaumont University Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, USA
| | - Maram Albandak
- Division of hospital medicine, University of Kentucky, Lexington, KY, USA; Department of Internal Medicine, University of Toledo, Toledo, Ohio, USA
| | - Laith Alhuneafat
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Fares Sukhon
- Heart and Vascular Center, Metrohealth Medical Center, Cleveland, OH, United States of America
| | - Zaid Shahrori
- Case Western Reserve University/Metrohealth Medical Center Cleveland, OH, USA
| | | | - Mohammed Mhanna
- Division of Cardiovascular Medicine, University of Iowa, IA, USA
| | - Gennaro Giustino
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; Michigan State University, College of Human Medicine, USA
| | - Dee Dee Wang
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; Michigan State University, College of Human Medicine, USA
| | - Ivan D Hanson
- Department of Cardiovascular Medicine, William Beaumont University Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, William Beaumont University Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, USA
| | - Mohammad AlQarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; Michigan State University, College of Human Medicine, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA; Michigan State University, College of Human Medicine, USA.
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Sá MP, Jacquemyn X, Van den Eynde J, Chu D, Serna‐Gallegos D, Ebels T, Clavel M, Pibarot P, Sultan I. Impact of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data of 122 989 Patients With 592 952 Patient-Years. J Am Heart Assoc 2024; 13:e033176. [PMID: 38533939 PMCID: PMC11179750 DOI: 10.1161/jaha.123.033176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions. METHODS AND RESULTS We performed a systematic review with meta-analysis of reconstructed time-to-event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Sixty-five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow-up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio [HR], 1.16 [95% CI, 1.13-1.18], P<0.001). At 20 years of follow-up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 [95% CI, 1.06-1.11], P<0.001; severe versus no PPM: HR, 1.29 [95% CI, 1.24-1.35], P<0.001). PPM was associated with higher risk of cardiac death, heart failure-related hospitalizations, and aortic valve reinterventions over time (P<0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta-regression analysis revealed that populations with more women tend to have higher HRs for all-cause death associated with PPM. CONCLUSIONS The results of the present study suggest that any degree of PPM is associated with poorer long-term outcomes following surgical aortic valve replacement and provide support for implementation of preventive strategies to avoid PPM after surgical aortic valve replacement.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | | | | | - Danny Chu
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | - Derek Serna‐Gallegos
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | - Tjark Ebels
- Department of Cardiothoracic Surgery, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - Marie‐Annick Clavel
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
- Department of Medicine, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Philippe Pibarot
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
- Department of Medicine, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Ibrahim Sultan
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
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3
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Rocha RV, Rao V. Prosthesis-Patient Mismatch After TAVI and Outcomes: Prevention Is the Best Medicine. Can J Cardiol 2024; 40:123-124. [PMID: 37898172 DOI: 10.1016/j.cjca.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023] Open
Affiliation(s)
- Rodolfo V Rocha
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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4
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Angellotti D, Manzo R, Castiello DS, Immobile Molaro M, Mariani A, Iapicca C, Nappa D, Simonetti F, Avvedimento M, Leone A, Canonico ME, Spaccarotella CAM, Franzone A, Ilardi F, Esposito G, Piccolo R. Echocardiographic Evaluation after Transcatheter Aortic Valve Implantation: A Comprehensive Review. Life (Basel) 2023; 13:1079. [PMID: 37240724 PMCID: PMC10221682 DOI: 10.3390/life13051079] [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: 03/06/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly popular treatment option for patients with severe aortic stenosis. Recent advancements in technology and imaging tools have significantly contributed to the success of TAVI procedures. Echocardiography plays a pivotal role in the evaluation of TAVI patients, both before and after the procedure. This review aims to provide an overview of the most recent technical advancements in echocardiography and their use in the follow-up of TAVI patients. In particular, the focus will be on the examination of the influence of TAVI on left and right ventricular function, which is frequently accompanied by other structural and functional alterations. Echocardiography has proven to be key also in detecting valve deterioration during extended follow-up. This review will provide valuable insights into the technical advancements in echocardiography and their role in the follow-up of TAVI patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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Rasheed NF, Stonebraker C, Li Z, Siddiqi U, Lee ACH, Li W, Lupo S, Cruz J, Cohen WG, Staub C, Rodgers D, Myren M, Combs P, Jeevanandam V, Hibino N. Figure of eight suture technique in aortic valve replacement decreases prosthesis-patient mismatch. J Cardiothorac Surg 2023; 18:117. [PMID: 37038197 PMCID: PMC10084672 DOI: 10.1186/s13019-023-02260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/03/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND While the pledget suture technique has been the standard for surgical aortic. valve replacement (AVR), discussion continues regarding the possibility of the nonpledget suture technique to produce superior structural and hemodynamic parameters. This study aims to assess the effectiveness of the figure-of-eight suture technique in AVR, as determined by the incidence of prosthesis-patient mismatch (PPM). METHODS We reviewed records of patients (N = 629) who underwent a surgical AVR procedure between January 2011 and July 2018 at a single institution. Indexed effective orifice area values and PPM incidence were calculated from implanted valve size and patient body surface area. Incidence of none, moderate, and severe PPM was compared across AVR suture techniques. RESULTS A total of 570 pledget and 59 figure-of-eight patients were compared for incidence of PPM. Patients who received AVR with the pledget suture technique had significantly lower echocardiographic measurements of baseline ejection fraction than patients who had received AVR with the figure-of-eight suture technique (p = 0.003). Patients who received the figure-of eight suture had a 14% decrease in moderate PPM compared to patients who received the pledget suture (p = 0.022). Patients who received the figure-of-eight suture also had a significantly higher rate of no PPM (p = 0.044). CONCLUSIONS The use of the figure-of-eight suture technique in AVR can reduce the incidence of moderate PPM. While the pledget suture is the standard technique in AVR, the figure-of-eight suture technique may offer better structural and hemodynamic outcomes, especially for patients with a smaller aortic annulus.
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Affiliation(s)
- Nabeel F Rasheed
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA.
| | - Corinne Stonebraker
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Zhaozhi Li
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Umar Siddiqi
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Andy C H Lee
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Willa Li
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Sydney Lupo
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Jennifer Cruz
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - William G Cohen
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Cathy Staub
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Daniel Rodgers
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Mark Myren
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Pamela Combs
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Valluvan Jeevanandam
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Narutoshi Hibino
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
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Pandey P, Saha A, Jha NK, Rao YM, Das D, Das M, Chatterjee D, Narayan P. Are small-sized mechanical valves adequate for patients with small aortic roots? Asian Cardiovasc Thorac Ann 2022; 30:992-1000. [PMID: 36120832 DOI: 10.1177/02184923221127661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Concerns have been raised over patient outcomes following implantation of small aortic valves (size: 19 and 17 mm). However, in patients with a smaller body surface area, these valves may be adequate. The aim of th study was to assess the hemodynamic and functional performance of these valves and their impact on clinical outcomes in patients with a small aortic root. MATERIAL AND METHODS This was a prospective observational study that included all consecutive patients undergoing aortic valve replacement (AVR) with a small-sized aortic valve over a 3-year period. Patients were followed up at 1 week, 6 weeks, and 1 year. Functional and clinical evaluation along with echocardiography was carried out for hemodynamic assessment. In-hospital mortality and hemodynamic outcomes at 1-year follow-up were recorded. RESULTS Isolated AVR with a size 17 mm valve was carried out in 15 (25%) and with a 19 mm valve in 45 (75%) patients. The mean annular size was 19.12 ± 2.03 mm. The mean indexed effective orifice area was 1.08 ± 0.16 cm2/m2. Satisfactory decrease in peak and mean trans-prosthetic gradient were evident (peak gradient preoperatively was 92.15 ± 26.2 mmHg, and 25.68 ± 12.28 mmHg at 1 year, mean gradient was 55.31 ± 17.41 mmHg preoperatively and 13.71 ± 7.39 mmHg at 1 year). The functional status of patients also showed significant improvement post AVR. Left ventricular ejection fraction pre-operatively was 59.67% ± 10.38% and 59.57% ± 7.98% at 1-week, 59.15% ± 8.17% at 6 weeks, and 59.59% ± 7.48% at 1 year. CONCLUSION When confronted with a small aortic root, AVR with a small-sized prosthesis provides a satisfactory hemodynamic and functional outcome. In patients with small body surface area, implantation of a small-sized valve is a viable option.
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Affiliation(s)
- Pratik Pandey
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Apu Saha
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Neeraj Kumar Jha
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | - Debasis Das
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Mrinalendu Das
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Debika Chatterjee
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Pradeep Narayan
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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Keshishi M, Chung J. Commentary: Five-year results of a novel surgical bioprosthetic valve look promising, but only time will tell. Eur J Cardiothorac Surg 2022; 62:6671841. [PMID: 35984311 DOI: 10.1093/ejcts/ezac407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Melanie Keshishi
- Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Chung
- Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Feier H, Mocan M, Grigorescu A, Falnita L, Gaspar M, Luca CT. Patient-Prosthesis Mismatch in Contemporary Small-Size Mechanical Prostheses Does Not Impact Survival at 10 Years. J Cardiovasc Dev Dis 2022; 9:48. [PMID: 35200701 PMCID: PMC8877093 DOI: 10.3390/jcdd9020048] [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] [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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Affiliation(s)
- Horea Feier
- Department of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania; (H.F.); (A.G.); (M.G.); (C.-T.L.)
- Research Center of the Institute for Cardiovascular Diseases, 300310 Timisoara, Romania;
| | - Mihaela Mocan
- Department of Cardiology, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Andrei Grigorescu
- Department of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania; (H.F.); (A.G.); (M.G.); (C.-T.L.)
- Research Center of the Institute for Cardiovascular Diseases, 300310 Timisoara, Romania;
| | - Lucian Falnita
- Research Center of the Institute for Cardiovascular Diseases, 300310 Timisoara, Romania;
| | - Marian Gaspar
- Department of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania; (H.F.); (A.G.); (M.G.); (C.-T.L.)
- Research Center of the Institute for Cardiovascular Diseases, 300310 Timisoara, Romania;
| | - Constantin-Tudor Luca
- Department of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania; (H.F.); (A.G.); (M.G.); (C.-T.L.)
- Research Center of the Institute for Cardiovascular Diseases, 300310 Timisoara, Romania;
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Arribas-Leal JM, Rivera-Caravaca JM, Aranda-Domene R, Moreno-Moreno JA, Espinosa-Garcia D, Jimenez-Aceituna A, Perez-Andreu J, Taboada-Martin R, Saura-Espin DR, Canovas-Lopez SJ. Mid-term outcomes of rapid deployment aortic prostheses in patients with small aortic annulus. Interact Cardiovasc Thorac Surg 2021; 33:695-701. [PMID: 34179967 DOI: 10.1093/icvts/ivab175] [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: 01/11/2021] [Revised: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The Edwards Intuity valve is a rapid deployment aortic prosthesis that favours less invasive approaches. However, evidence about the clinical behaviour of their smaller sizes is scarce. Herein, we studied haemodynamic behaviours and clinical outcomes of small Intuity prostheses (19-21 mm) in comparison to larger Intuity prostheses (>21 mm). METHODS This is an observational study including patients implanted with an Edwards Intuity rapid deployment aortic prosthesis. Patients with prosthesis sizes 19-21 and >21 mm were included. Baseline and perioperative variables, as well as adverse events during the follow-up were recorded and compared between groups. RESULTS A total of 122 patients (37% female, mean age 75 ± 4.5 years) were included, of whom 54 (45%) were implanted with a small prosthesis and 68 (55%) with a prosthesis >21 mm. There were no significant differences between patients with small Intuity prostheses and patients with larger prostheses regarding in-hospital mortality (2% vs 4%, P = 0.43) or mortality during the follow-up (3.41 vs 2.45 per 100 patients-years; P = 0.58). Survival in the small Intuity valve group was 95% at 1 year and 83% at 6 years, whereas in the larger Intuity valve group was 96% at 1 year and 78% at 6 years. The presence of a small prosthesis did not influence mid-term survival (log-rank P-value = 0.62). CONCLUSIONS This study showed good clinical performance of Intuity aortic prostheses with appropriate mid-term survival in patients with the small aortic annulus. Thus, the Edwards Intuity rapid deployment aortic prosthesis may be considered as a potential option in patients with the small aortic annulus.
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Affiliation(s)
- José M Arribas-Leal
- Cardiovascular Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Ramón Aranda-Domene
- Cardiovascular Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - José A Moreno-Moreno
- Cardiovascular Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Dolores Espinosa-Garcia
- Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Antonio Jimenez-Aceituna
- Cardiovascular Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Joaquín Perez-Andreu
- Cardiovascular Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Rubén Taboada-Martin
- Cardiovascular Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Daniel R Saura-Espin
- Department of Cardiology, Virgen de la Arrixaca University Hospital, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Sergio J Canovas-Lopez
- Cardiovascular Surgery Service, Virgen de la Arrixaca University Hospital, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
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Ösken A, Ünal Dayı Ş, Özcan KS, Keskin M, Kemaloğlu Öz T, Poyraz E, Gürkan U, Akgöz H, Çam N. Speckle tracking echocardiography in severe patient-prosthesis mismatch. Herz 2021; 46:375-380. [PMID: 33687479 DOI: 10.1007/s00059-021-05031-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/06/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although aortic valve replacement (AVR) when successfully performed boasts low mortality rates in selected patients, prosthesis-patient mismatch (PPM) can be found in the majority of these individuals. Limited research is available supporting the benefit of two-dimensional speckle tracking echocardiography (2D-STE) in patients with severe PPM. This study sought to assess myocardial strain using 2D-STE to determine the relationship between subclinical left ventricular (LV) dysfunction and aortic PPM in patients undergoing AVR with preserved LV ejection fraction. MATERIAL AND METHODS We retrospectively examined all consecutive patients with isolated AVR who presented to our center from 2005 to 2018. The data of 1086 patients were analyzed. Severe PPM was defined as an indexed effective orifice area of 0.65 cm2/m2 or less. As a result of the detailed assessment, 54 patients meeting the eligibility criteria were included in the study. Baseline data were collected and compared between the two groups of patients with severe PPM (n = 27) and those with normofunctional aortic prosthesis valve as a control group (n = 27). All patients underwent baseline echocardiography. Global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 2D-STE. RESULTS When compared with controls, patients with severe PPM had significantly decreased GLS (18.6 ± 2.9 vs. 21.4 ± 2.1; p < 0.01) and GCS (17.2 ± 3.6 vs. 21.7 ± 2.1; p < 0.01) values. CONCLUSION In addition to standard clinical and echocardiographic parameters, GLS and GCS suggest subclinical dysfunction and have incremental value in patients with severe PPM.
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Affiliation(s)
- Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. .,Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tibbiye cad. 13, Haydarpasa/Istanbul/Turkey, 34668, İstanbul, Turkey.
| | - Şennur Ünal Dayı
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kazım Serhan Özcan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Tuğba Kemaloğlu Öz
- Department of Cardiology, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Esra Poyraz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Gürkan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Haldun Akgöz
- Department of Cardiology, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Neşe Çam
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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11
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Theron A, Lavagna F, Gaubert G, Resseguier N, Porto A, Ferrara J, Jaussaud N, Morera P, Cuisset T, Deharo P, Collart F. Prosthesis-patient mismatch is an independent predictor of congestive heart failure after transcatheter aortic valve replacement. Arch Cardiovasc Dis 2021; 114:504-514. [PMID: 33509746 DOI: 10.1016/j.acvd.2020.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/15/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the effect of prosthesis-patient mismatch (PPM) on outcomes after transcatheter aortic valve replacement. We reported previously an increased risk of PPM with the SAPIEN 3 transcatheter heart valve (S3-THV). AIMS To investigate the association of PPM with 1-year outcomes in patients with severe aortic stenosis (AS) implanted with S3-THV. METHODS Moderate PPM was defined by an indexed effective orifice area (iEOA)≤0.85cm2/m2, and severe PPM by an iEOA<0.65cm2/m2. Inclusion criteria were severe symptomatic AS and implantation with S3-THV. The primary endpoint was hospitalization for congestive heart failure (CHF) at 1 year; the secondary endpoint was all-cause mortality. RESULTS A total of 208 consecutive patients were included between 2016 and 2018. Male sex was prevalent (53.8%), mean age was 81.9±6.2 years, mean EuroSCORE II was 4.35±3.37, mean LVEF was 57.9±13%. Moderate and severe PPM were observed in 69 (33.2%) and 10 (4.8%) patients. Patients with PPM were younger (80.4±7 vs 82.8±5.41 years; P=0.006), had a larger BSA (1.84±0.19 vs 1.77±0.19 m2; P=0.01), a lower iEOA (0.73±0.08 vs 1.11±0.22 cm2/m2; P<0.001) and a higher mean gradient (14±4.6 vs 11.9±3.9mmHg; P<0.001). CHF occurred in 16.5% vs 7% (P=0.03). By multivariable analysis, PPM was independently associated with CHF (hazard ratio [HR] 3.17, 95% confidence interval [CI] 1.17 to 8.55; P=0.032), especially in patients with mitral regurgitation≥2/4 (HR>100, 95%CI>100 to>1000; P<0.01). PPM did not correlate with all-cause mortality (HR 0.90, 95%CI 0.22 to 3.03; P=0.86). CONCLUSIONS PPM after S3-THV implantation is strongly associated with CHF at 1 year, but is not correlated with overall mortality.
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Affiliation(s)
- Alexis Theron
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - Flora Lavagna
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | | | | | - Alizée Porto
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Jerome Ferrara
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Nicolas Jaussaud
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Pierre Morera
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
| | - Thomas Cuisset
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Pierre Deharo
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France; C2VN, Inserm, Inra, Aix-Marseille University, 13005 Marseille, France; Faculty of Medicine, Aix-Marseille University, 13385 Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, 264, rue Saint-Pierre, 13005 Marseille, France
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12
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Chau KH, Douglas PS, Pibarot P, Hahn RT, Khalique OK, Jaber WA, Cremer P, Weissman NJ, Asch FM, Zhang Y, Gertz ZM, Elmariah S, Clavel MA, Thourani VH, Daubert M, Alu MC, Leon MB, Lindman BR. Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 75:2446-2458. [DOI: 10.1016/j.jacc.2020.03.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/15/2020] [Indexed: 12/20/2022]
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13
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Prosthesis–patient mismatch in high-risk patients with severe aortic stenosis: A randomized trial of a self-expanding prosthesis. J Thorac Cardiovasc Surg 2016; 151:1014-22, 1023.e1-3. [DOI: 10.1016/j.jtcvs.2015.10.070] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/03/2015] [Accepted: 10/08/2015] [Indexed: 11/21/2022]
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14
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Popma JJ, Khabbaz K. Prosthesis-Patient Mismatch After “High-Risk” Aortic Valve Replacement∗. J Am Coll Cardiol 2014; 64:1335-8. [DOI: 10.1016/j.jacc.2014.07.952] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
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15
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Piazza N, Kalesan B, van Mieghem N, Head S, Wenaweser P, Carrel TP, Bleiziffer S, de Jaegere PP, Gahl B, Anderson RH, Kappetein AP, Lange R, Serruys PW, Windecker S, Jüni P. A 3-Center Comparison of 1-Year Mortality Outcomes Between Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement on the Basis of Propensity Score Matching Among Intermediate-Risk Surgical Patients. JACC Cardiovasc Interv 2013; 6:443-51. [DOI: 10.1016/j.jcin.2013.01.136] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/08/2013] [Accepted: 01/23/2013] [Indexed: 10/26/2022]
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16
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17
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Magne J, Mathieu P, Dumesnil JG, Tanné D, Dagenais F, Doyle D, Pibarot P. Impact of Prosthesis-Patient Mismatch on Survival After Mitral Valve Replacement. Circulation 2007; 115:1417-25. [PMID: 17339554 DOI: 10.1161/circulationaha.106.631549] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We recently reported that valve prosthesis-patient mismatch (PPM) is associated with persisting pulmonary hypertension after mitral valve replacement. Thus, the objective of this study was to evaluate the impact of PPM on mortality in patients undergoing mitral valve replacement.
Methods and Results—
The indexed valve effective orifice area was estimated for each type and size of prosthesis being implanted in 929 consecutive patients and used to define PPM as not clinically significant if >1.2 cm
2
/m
2
, as moderate if >0.9 and ≤1.2 cm
2
/m
2
, and as severe if ≤0.9 cm
2
/m
2
. Moderate PPM was present in 69% of patients; severe PPM was seen in 9%. For patients with severe PPM, 6-year survival (74±5%) and 12-year survival (63±7%) were significantly less than for patients with moderate PPM (84±1% and 76±2%;
P
=0.027) or nonsignificant PPM (90±2% and 82±4%;
P
=0.002). On multivariate analysis, severe PPM was associated with higher mortality (hazard ratio, 3.2; 95% confidence interval, 1.5 to 6.8;
P
=0.003).
Conclusions—
Severe PPM is an independent predictor of mortality after mitral valve replacement. As opposed to other independent risk factors, PPM may be avoided or its severity may be reduced with the use of a prospective strategy at the time of operation. For patients identified as being at risk for severe PPM, every effort should be made to implant a prosthesis with a larger effective orifice area.
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Affiliation(s)
- Julien Magne
- Laval Hospital Research Center/Québec Heart Institute, Faculty of Medicine, Laval University, Québec, Canada
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18
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Ali A, Halstead JC, Cafferty F, Sharples L, Rose F, Coulden R, Lee E, Dunning J, Argano V, Tsui S. Are Stentless Valves Superior to Modern Stented Valves?: A Prospective Randomized Trial. Circulation 2006; 114:I535-40. [PMID: 16820633 DOI: 10.1161/circulationaha.105.000950] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is presumed that stentless aortic bioprostheses are hemodynamically superior to stented bioprostheses. A prospective randomized controlled trial was undertaken to compare stentless versus modern stented valves. METHODS AND RESULTS Patients with severe aortic valve stenosis (n=161) undergoing aortic valve replacement (AVR) were randomized intraoperatively to receive either the C-E Perimount stented bioprosthesis (n=81) or the Prima Plus stentless bioprosthesis (n =80). We assessed left ventricular mass (LVM) regression with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Transvalvular gradients were measured postoperatively by Doppler echocardiography to compare hemodynamic performance. There was no difference between groups with regard to age, symptom status, need for concomitant coronary artery bypass surgery, or baseline LVM. LVM regressed in both groups but with no significant difference between groups at 1 year. In a subset of 50 patients, MRI was also used to assess LVM regression, and again there was no significant difference between groups at 1 year. Hemodynamic performance of the 2 valves was similar with no difference in mean and peak systolic transvalvular gradients 1 year after surgery. In patients with reduced ventricular function (left ventricular ejection fraction [LVEF] <60%), there was a significantly greater improvement in LVEF from baseline to 1 year in stentless valve recipients. CONCLUSIONS Both stented and stentless bioprostheses are associated with excellent clinical and hemodynamic outcomes 1 year after AVR. Comparable hemodynamics and LVM regression can be achieved using a second-generation stented pericardial bioprosthesis. In patients with ventricular impairment, stentless bioprostheses may allow for greater improvement in left ventricular function postoperatively.
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Affiliation(s)
- Ayyaz Ali
- Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge, CB3 8RE, UK
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19
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Tasca G, Mhagna Z, Perotti S, Centurini PB, Sabatini T, Amaducci A, Brunelli F, Cirillo M, Dalla Tomba M, Quaini E, Quiani E, Troise G, Pibarot P. Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic Stenosis. Circulation 2006; 113:570-6. [PMID: 16401767 DOI: 10.1161/circulationaha.105.587022] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthesis being implanted is too small in relation to body size, thus causing abnormally high transvalvular pressure gradients. The objective of this study was to examine the midterm impact of PPM on overall mortality and cardiac events after aortic valve replacement in patients with pure aortic stenosis.
Methods and Results—
The indexed EOA (EOAi) was estimated for each type and size of prosthesis being implanted in 315 consecutive patients with pure aortic stenosis. PPM was defined as an EOAi ≤0.80 cm
2
/m
2
and was correlated with overall mortality and cardiac events. PPM was present in 47% of patients. The 5-year overall survival and cardiac event-free survival were 82±3% and 75±4%, respectively, in patients with PPM compared with 93±3% and 87±4% in patients with no PPM (
P
≤0.01). In multivariate analysis, PPM was associated with a 4.2-fold (95% CI, 1.6 to 11.3) increase in the risk of overall mortality and 3.2-fold (95% CI, 1.5 to 6.8) increase in the risk of cardiac events. The other independent risk factors were history of heart failure, NHYA class III-IV, severe left ventricular hypertrophy, and absence of normal sinus rhythm before operation.
Conclusions—
PPM is an independent predictor of cardiac events and midterm mortality in patients with pure aortic stenosis undergoing aortic valve replacement. As opposed to other risk factors, PPM may be avoided or its severity may be reduced with the use of a preventive strategy at the time of operation.
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Affiliation(s)
- Giordano Tasca
- Department of Cardiac Surgery, Private Nonprofit Hospital Poliambulanza, Brescia, Italy.
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20
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Mohty D, Mohty-Echahidi D, Malouf JF, Girard SE, Schaff HV, Grill DE, Enriquez-Sarano ME, Miller FA. Impact of Prosthesis-Patient Mismatch on Long-Term Survival in Patients With Small St Jude Medical Mechanical Prostheses in the Aortic Position. Circulation 2006; 113:420-6. [PMID: 16415379 DOI: 10.1161/circulationaha.105.546754] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The impact of aortic prosthesis-patient mismatch (P-PtM) on long-term survival is unclear.
Methods and Results—
Between 1985 and 2000, 388 patients at Mayo Clinic in Rochester, Minn, underwent aortic valve replacement (AVR) with 19- or 21-mm St Jude Medical prostheses and had transthoracic echocardiography within 1 year after AVR. Mean age of patients was 62±13 years; 69% were female. Prosthesis effective orifice area (EOA) was derived from the continuity equation. P-PtM was classified as severe (indexed EOA ≤0.60 cm
2
/m
2
), moderate (0.60 cm
2
/m
2
<indexed EOA≤0.85 cm
2
/m
2
), or not hemodynamically significant (indexed EOA >0.85 cm
2
/m
2
). P-PtM was severe in 66 patients (17%), moderate in 168 (43%), and not hemodynamically significant in 154 (40%). Patients with severe P-PtM had a significantly larger body surface area (
P
<0.0001), higher mean gradient (
P
<0.0001), lower preoperative (
P
<0.0001) and postoperative (
P
<0.0001) ejection fractions, and lower stroke volume (
P
<0.0001) and more often received a 19-mm prosthesis (
P
=0.0008) than patients with moderate or no hemodynamically significant mismatch. For patients with severe mismatch, 5-year survival rates (72±6%) and 8-year survival rates (41±8%) were significantly less than for patients with moderate mismatch (80±3% and 65±5%;
P
=0.026) or no hemodynamically significant mismatch (85±3% and 74±5%;
P
=0.002). On multivariate analysis after adjustment for other predictors of outcome, severe mismatch was associated with higher mortality (hazard ratio 2.18; 95% confidence interval 1.24 to 3.85;
P
=0.007) and higher incidence of congestive heart failure (hazard ratio 3.1; 95% confidence interval 1.3 to 7.4;
P
=0.009) than no hemodynamically significant mismatch.
Conclusions—
Severe P-PtM is an independent predictor of higher long-term mortality and congestive heart failure in patients with small St Jude Medical aortic valve prostheses. For patients undergoing AVR who are at risk of severe mismatch, every effort should be made to use a larger prosthesis or to consider a prosthesis with a larger EOA.
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Affiliation(s)
- Dania Mohty
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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21
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Koch CG, Khandwala F, Estafanous FG, Loop FD, Blackstone EH. Impact of Prosthesis–Patient Size on Functional Recovery After Aortic Valve Replacement. Circulation 2005; 111:3221-9. [PMID: 15956129 DOI: 10.1161/circulationaha.104.505248] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Prosthesis–patient size mismatch results when an implanted prosthetic aortic valve is of insufficient size for a patient’s body surface area. The relation between prosthesis–patient size and functional capacity and adverse postoperative outcome is inconsistent. Our objectives were to examine the impact of valve replacement, continuous prosthesis–patient size, and other factors on functional recovery after aortic valve replacement (AVR) with the Duke Activity Status Index (DASI).
Methods and Results—
From June 15, 1995, through May 14, 1998, 1108 patients underwent AVR after completing a DASI survey. Of these, 1014 completed a postoperative DASI survey at an average of 8.3 months postoperatively. Logistic ordinal regression was used to examine the influence of demographic variables, comorbidities, baseline DASI scores, indexed valve orifice area, standardized orifice size, and postoperative morbid events on postoperative DASI. There was overall improvement in postoperative functional recovery reflected by median preoperative and postoperative DASI scores of 29 and 46,
P
<0.001, respectively. Neither indexed orifice area,
P
=0.94, nor standardized orifice size,
P
=0.96, was associated with functional recovery. Female sex, increasing age, elevated serum creatinine, increased central venous pressure, and red blood cell transfusion were factors associated with poor postoperative functional recovery.
Conclusions—
A majority of patients report improvement in functional quality of life early after AVR. Similar functional recovery was demonstrated for patients along the full spectrum of valve sizes indexed to body size, even for values considered to represent severe mismatch for patient size. Factors other than prosthesis–patient size influence functional quality of life early after AVR.
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Affiliation(s)
- Colleen Gorman Koch
- Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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22
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23
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Li M, Dumesnil JG, Mathieu P, Pibarot P. Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement. J Am Coll Cardiol 2005; 45:1034-40. [PMID: 15808760 DOI: 10.1016/j.jacc.2004.10.073] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 10/14/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We sought to determine the impact of valve prosthesis-patient mismatch (PPM) on pulmonary arterial (PA) pressure after mitral valve replacement (MVR). BACKGROUND Pulmonary arterial hypertension is a serious complication of mitral valve disease, and it is a major risk factor for poor outcome after MVR. We hypothesized that valve PPM might be a determinant of PA hypertension after MVR. METHODS Systolic PA pressure was measured by Doppler echocardiography in 56 patients with normally functioning mitral prosthetic valves. Mitral valve effective orifice area (EOA) was determined by the continuity equation and indexed for body surface area. RESULTS Thirty patients (54%) had PA hypertension defined as systolic PA pressure >40 mm Hg, whereas 40 patients (71%) had PPM defined as an indexed EOA < or =1.2 cm(2)/m(2). There was a significant correlation (r = 0.64) between systolic PA pressure and indexed EOA. The average systolic PA pressure and prevalence of PA hypertension were 34 +/- 8 mm Hg and 19% in patients with no PPM versus 46 +/- 8 mm Hg and 68% in patients with PPM (p < 0.001). In multivariate analysis, the indexed EOA was by far the strongest predictor of systolic PA pressure. CONCLUSIONS Persistent PA hypertension is frequent after MVR and strongly associated with the presence of PPM. The clinical implications of these findings are important given that PPM can largely be avoided by using a simple prospective strategy at the time of operation.
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Affiliation(s)
- Mingzhou Li
- Research Group in Valvular Heart Diseases, Research Center of Laval Hospital/Quebec Heart Institute, Laval University, 2725 Chemin Saint-Foy, Sainte-Foy, Quebec, Canada G1V 4G5
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