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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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Abbas AE, Ternacle J, Pibarot P, Xu K, Alu M, Rogers E, Hahn RT, Leon M, Thourani VH. Impact of Flow on Prosthesis-Patient Mismatch Following Transcatheter and Surgical Aortic Valve Replacement. Circ Cardiovasc Imaging 2021; 14:e012364. [PMID: 34387097 DOI: 10.1161/circimaging.120.012364] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe prosthesis-patient mismatch (PPM) is diagnosed by an indexed effective orifice area <0.65 cm2/m2, which is derived from stroke volume index. We examined the impact of flow, determined by stroke volume index, on severe PPM following transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS We included SAVR patients from the PARTNER 2A trial (Placement of Aortic Transcatheter Valve 2A) and TAVR patients from the PARTNER 2 S3i (Placement of Aortic Transcatheter Valve 2 S3i) registry. The primary end point was the separate analysis of all-cause death, cardiac death, and rehospitalization at 5 years. Following TAVR and SAVR, we compared the primary end points between severe versus no-severe PPM in all patients, in low flow (LF), and in normal flow. Multivariable analysis was performed to determine variables associated with the end points. RESULTS Nine hundred fifty-four TAVR and 726 SAVR patients with PPM and flow data were included. Severe PPM following TAVR was significantly lower compared with SAVR in all patients (9% versus 28%, P<0.0001), in normal flow (5% versus 8%, P=0.04), and in LF (20% versus 42%, P<0.0001). Severe PPM was associated with rehospitalization following TAVR (odds ratio, 1.52 [95% CI, 1.01-2.29], P=0.0456) and SAVR (odds ratio, 1.51 [95% CI, 1.06-2.16], P=0.0237). Severe PPM in LF was independently associated with cardiac death following TAVR (odds ratio, 1.85 [95% CI, 1.06-3.23], P=0.0308). Following SAVR, severe PPM in LF and low ejection fraction was associated with increased cardiac death (35.26% versus 12.51%, P=0.01) and rehospitalization (37.59% versus 15.46%, P=0.006) compared with severe PPM in LF and preserved ejection fraction, respectively. Severe PPM in normal flow was not associated with clinical outcomes despite higher gradients and smaller valves compared with severe PPM in LF. CONCLUSIONS Severe PPM is more common following SAVR compared with TAVR. Regardless of the implanted valve size or gradient, severe PPM impacts mortality only in patients with LF following TAVR and LF and low ejection fraction following SAVR. Severe PPM in normal flow is not associated with poor outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT02687035.
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Affiliation(s)
- Amr E Abbas
- Department of Internal Medicine. Oakland University William Beaumont School of Medicine, Auburn Hills, MI (A.E.A.).,Department of Cardiovascular Medicine. Beaumont Hospital Royal Oak, MI (A.E.A.)
| | - Julien Ternacle
- Institut Universitaire de cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., P.P.)
| | - Philippe Pibarot
- Institut Universitaire de cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., P.P.)
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Maria Alu
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Erin Rogers
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Rebecca T Hahn
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Martin Leon
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T)
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Ternacle J, Guimaraes L, Vincent F, Côté N, Côté M, Lachance D, Clavel MA, Abbas AE, Pibarot P, Rodés-Cabau J. Reclassification of prosthesis-patient mismatch after transcatheter aortic valve replacement using predicted vs. measured indexed effective orifice area. Eur Heart J Cardiovasc Imaging 2021; 22:11-20. [PMID: 32995865 DOI: 10.1093/ehjci/jeaa235] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS The objective was to compare the incidence and impact on outcomes of measured (PPMM) vs. predicted (PPMP) prosthesis-patient mismatch following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS All consecutives patients who underwent TAVR between 2007 and 2018 were included. Effective orifice area (EOA) was measured by Doppler-echocardiography using the continuity equation and predicted according to the normal reference for each model and size of valve. PPM was defined using EOA indexed (EOAi) to body surface area as moderate if ≤0.85 cm2/m2 and severe if ≤ 0.65 cm2/m2 (respectively, ≤ 0.70 and ≤ 0.55 cm2/m2 if body mass index ≥ 30 kg/m2). The outcome endpoints were high residual gradient (≥20 mmHg) and the composite of cardiovascular mortality and hospital readmission for heart failure at 1 year. Overall, 1088 patients underwent a TAVR (55% male, age 79.1 ± 8.4 years, and STS score 6.6 ± 4.7%); balloon-expandable device was used in 83%. Incidence of moderate (10% vs. 27%) and severe (1% vs. 17%) PPM was markedly lower when defined by predicted vs. measured EOAi (P < 0.001). Balloon-expandable device implantation (OR: 1.90, P = 0.029) and valve-in-valve procedure (n = 118; OR: 3.21, P < 0.001) were the main factors associated with PPM occurrence. Compared with measured PPM, predicted PPM showed stronger association with high residual gradient. Severe measured or predicted PPM was not associated with clinical outcomes. CONCLUSION The utilization of the predicted EOAi reclassifies the majority of patients with PPM to no PPM following TAVR. Compared with measured PPM, predicted PPM had stronger association with haemodynamic outcomes, while both methods were not associated with clinical outcomes.
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Affiliation(s)
- Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
- Cardiology Department, Expert Valve Center, Henri Mondor ho spital, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
- INSERM Unit U955, Team 8, Paris-Est Creteil University, Val-de-Marne, 8 rue du Général Sarrail, 94010, Créteil, France
| | - Leonardo Guimaraes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Flavien Vincent
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
- Département de cardiologie, CHU de Lille, Institut Cœur Poumon, Université de Lille, INSERM U1011, Institut Pasteur de Lille, EGID, Boulevard du Professeur Jules Leclercq, 59000 Lille,, France
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Mélanie Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Dominique Lachance
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Amr E Abbas
- Oakland University William Beaumont School of Medicine, Auburn Hills, 586 Pioneer Dr, Rochester, MI 48309, USA
- Beaumont Health, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
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Abbas AE, Mando R, Hanzel G, Goldstein J, Shannon F, Pibarot P. Hemodynamic principles of prosthetic aortic valve evaluation in the transcatheter aortic valve replacement era. Echocardiography 2020; 37:738-757. [DOI: 10.1111/echo.14663] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/28/2020] [Accepted: 03/29/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Amr E. Abbas
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | | | - George Hanzel
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | - James Goldstein
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | - Francis Shannon
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
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Rahmanian PB, Eghbalzadeh K, Giese D, Kuhn EW, Djordjevic I, Kaya S, Weber C, Baldus S, Mader N, Wahlers TC. SAVR versus TAVI: What about the Hemodynamic Performance? An In Vivo and In Vitro Analysis. Thorac Cardiovasc Surg 2019; 68:608-615. [DOI: 10.1055/s-0039-1695779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Background Surgical aortic valve replacement (SAVR) is nowadays discussed whether it remains the gold standard of treatment. In the last decade, there has been a tremendous increase in transcatheter aortic valve implantation (TAVI) due to the growing expertise and excellent results of the catheter-based approach. We, therefore, retrospectively compared the rapid deployment valve (RDV), the Edwards Intuity valve (IEV), with the Edwards Sapien 3 (S3V) with regard to post-procedural hemodynamics.
Methods A total of 246 patients treated with TAVI or SAVR between February 2009 and November 2015 were included. One-hundred twenty-five patients were analyzed in the SAVR group and compared with 121 patients undergoing TAVI. Transvalvular pressure gradients (PGs) and the incidence and extent of aortic regurgitation (AR) were compared post-procedurally by echocardiography for each valve size. In vitro hemodynamics were analyzed by placing both valves into an aortic silicone phantom connected to a pulsatile flow pump and measured using phase-contrast magnetic resonance imaging (4D flow MRI).
Results Post-procedurally, mean transvalvular PGs for the 23 mm valves were 9 (7;11.5) versus 13 (9;18) (p < 0.001), whereas maximum PGs were 16.5 (14;22) versus 25.5 mm Hg (17.5;34) (p < 0.001) in IEV and S3V patients, respectively. The 21 mm IEV showed significantly lower transvalvular PGs compared with the 23 mm S3V: mean PGs: 11 (8;13) versus 13 (9;18) (p < 0.05); maximum PG: 19.5 (13;24) versus 25.5 (18;34) mm Hg (p < 0.05). Analysis revealed significantly lower post-procedural transvalvular PGs for larger valves sizes. With respect to AR, the incidence of AR was significantly lower in IEV group (p < 0.05). In vitro velocities and turbulent kinetic energy values showed similar results between both valves.
Conclusion Implanted RDVs presented a lower incidence of paravalvular regurgitation and were associated with significantly lower post-procedural transvalvular PGs, especially for small valve sizes. Our data might support the application of rapid deployment aortic valves in patients with small aortic annulus in the TAVI era.
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Affiliation(s)
| | | | - Daniel Giese
- Department of Radiology, Uniklinik Koln, Koln, Germany
| | - Elmar W. Kuhn
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
| | - Süreyya Kaya
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
| | - Stephan Baldus
- Department of Cardiology, University of Cologne, Heart Center, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Uniklinik Koln, Koln, Germany
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Amadeo F, Boschetti F, Polvani G, Banfi C, Pesce M, Santoro R. Aortic valve cell seeding into decellularized animal pericardium by perfusion-assisted bioreactor. J Tissue Eng Regen Med 2018; 12:1481-1493. [PMID: 29702745 DOI: 10.1002/term.2680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/28/2018] [Accepted: 04/16/2018] [Indexed: 12/19/2022]
Abstract
Animal-derived pericardium is the elective tissue employed in manufacturing heart valve prostheses. The preparation of this tissue for biological valve production consists of fixation with aldehydes, which reduces, but not eliminates, the xenoantigens and the donor cellular material. As a consequence, especially in patients below 65-70 years of age, the employment of valve substitutes contaning pericardium is not indicated due to progressive calcification that causes tissue degeneration and recurrence of valve insufficiency. Decellularization with ionic or nonionic detergents has been proposed as an alternative procedure to prepare aldehyde- or xenoantigen-free pericardium for biological valve manufacturing. In the present contribution, we optimized a decellularization procedure that is permissive for seeding and culturing valve competent cells able to colonize and reconstitute a valve-like tissue. A high-efficiency cellularization was achieved by forcing cell penetration inside the pericardium matrix using a perfusion bioreactor. Because the decellularization procedure was found not to alter the collagen composition of the pericardial matrix and cells seeded in the tissue constructs consistently grew and acquired the phenotype of "quiescent" valve interstitial cells, our investigation sets a novel standard in pericardium application for tissue engineering of "living" valve implants.
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Affiliation(s)
- Francesco Amadeo
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Gianluca Polvani
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
| | - Cristina Banfi
- Unità di Proteomica, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Rosaria Santoro
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging 2016; 9:924-33. [DOI: 10.1016/j.jcmg.2015.10.026] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022]
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Kamperidis V, van Rosendael PJ, de Weger A, Katsanos S, Regeer M, van der Kley F, Mertens B, Sianos G, Ajmone Marsan N, Bax JJ, Delgado V. Surgical sutureless and transcatheter aortic valves: hemodynamic performance and clinical outcomes in propensity score-matched high-risk populations with severe aortic stenosis. JACC Cardiovasc Interv 2016; 8:670-7. [PMID: 25946438 DOI: 10.1016/j.jcin.2014.10.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/10/2014] [Accepted: 10/23/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES In propensity score-matched patients with severe aortic stenosis treated with surgical aortic valve replacement (AVR) with the 3f Enable sutureless prosthesis (Medtronic, Minneapolis, Minnesota) or transcatheter aortic valve replacement (TAVR), the hemodynamic performance of both valves and mid-term survival of patients were evaluated. BACKGROUND Data on hemodynamic performance of surgical sutureless bioprostheses in high operative risk patients with aortic stenosis are scarce. METHODS Of 258 patients undergoing TAVR or surgical aortic valve replacement with the 3f Enable valve, 80 (79 ± 5 years of age, 100% men) were included in the current analysis on the basis of propensity score 1:1 matching for baseline clinical and hemodynamic characteristics. All patients had hemodynamic echocardiographic evaluation at baseline and discharge. Mid-term survival was analyzed. RESULTS Compared with the 3f Enable valve, TAVR prostheses (Edwards SAPIEN XT [Edwards Lifesciences, Irvine, California] and CoreValve [Medtronic]) had larger effective orifice area index (1.00 ± 0.30 cm(2)/m(2) vs. 0.76 ± 0.22 cm(2)/m(2); p < 0.001), lower pressure gradient (8.14 ± 4.21 mm Hg vs. 10.72 ± 4.01 mm Hg; p = 0.006), less frequent prosthesis-patient mismatch (30.0% vs. 67.5%; p = 0.001), and low flow (46.2% vs. 72.5%; p = 0.02), but more frequent aortic regurgitation (87.5% vs. 20.0%; p < 0.001). The presence of prosthesis-patient mismatch was independently associated with a low-flow state at discharge (odds ratio: 4.70; p = 0.004) and independently associated with the use of the sutureless prosthesis (odds ratio: 3.90; p = 0.02). However, the survival of the 2 groups was comparable after 1.5-year (interquartile range: 0.79 to 2.01 years) follow-up (log-rank test, p = 0.95). CONCLUSIONS TAVR prostheses demonstrated better hemodynamics than the 3f Enable valve but a higher incidence of aortic regurgitation. However, these differences did not influence mid-term survival of patients.
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Affiliation(s)
- Vasileios Kamperidis
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands; 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Philippe J van Rosendael
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Arend de Weger
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Spyridon Katsanos
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Madelien Regeer
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Frank van der Kley
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart Mertens
- Medical Statistics Department, Leiden University Medical Center, Leiden, the Netherlands
| | - Georgios Sianos
- 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.
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Fouquet O, Flecher E, Nzomvuama A, Remadi JP, Bière L, Donal E, Levy F, Dalmayrac E, Szymanski C, Leguerrier A, Tribouilloy C. Haemodynamic performance of the small supra-annular Trifecta bioprosthesis: results from a French multicentre study. Interact Cardiovasc Thorac Surg 2016; 22:439-44. [DOI: 10.1093/icvts/ivv363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/17/2015] [Indexed: 11/12/2022] Open
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Comparison of outcomes and presentation in men-versus-women with bicuspid aortic valves undergoing aortic valve replacement. Am J Cardiol 2015; 116:250-5. [PMID: 25983125 DOI: 10.1016/j.amjcard.2015.04.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 11/22/2022]
Abstract
Gender disparities in short- and long-term outcomes have been documented in cardiac and valvular heart surgery. However, there is a paucity of data regarding these differences in the bicuspid aortic valve (BAV) population. The aim of this study was to examine gender-specific differences in short- and long-term outcomes after surgical aortic valve (AV) replacement in patients with BAV. A retrospective analysis was performed in 628 consecutive patients with BAV who underwent AV surgery from April 2004 to December 2013. To reduce bias when comparing outcomes by gender, propensity score matching obtained on the basis of potential confounders was used. Women with BAV who underwent AV surgery presented with more advanced age (mean 60.7 ± 13.8 vs 56.3 ± 13.6 years, p <0.001) and less aortic regurgitation (29% vs 44%, p <0.001) and had a higher risk for in-hospital mortality (mean Ambler score 3.4 ± 4.4 vs 2.5 ± 4.0, p = 0.015). After propensity score matching, women received more blood products postoperatively (48% vs 34%, p = 0.028) and had more prolonged postoperative lengths of stay (median 5 days [interquartile range 5 to 7] vs 5 days [interquartile range 4 to 6], p = 0.027). Operative, discharge, and 30-day mortality and overall survival were not significantly different. In conclusion, women with BAV who underwent AV surgery were older, presented with less aortic regurgitation, and had increased co-morbidities, lending higher operative risk. Although women received more blood products and had significantly longer lengths of stay, short- and long-term outcomes were similar.
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Chacko J, Ansari AH, McCarthy PM, Malaisrie SC, Andrei AC, Li Z, Lee R, McGee E, Bonow RO, Puthumana JJ. Response to letter regarding article, "Prosthesis-patient mismatch in bovine pericardial aortic valves: evaluation using 3 different modalities and associated medium-term outcomes". Circ Cardiovasc Imaging 2014; 7:210. [PMID: 24449552 DOI: 10.1161/circimaging.113.001333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jacob Chacko
- Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL
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House CM, Nelson WB, Pibarot P. Letter by House et al regarding article, "Prosthesis-patient mismatch in bovine pericardial aortic valves: evaluation using 3 different modalities and associated medium-term outcomes". Circ Cardiovasc Imaging 2014; 7:209. [PMID: 24449551 DOI: 10.1161/circimaging.113.001263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chad M House
- Department of Cardiology, Regions Hospital, St. Paul, MN
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