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Kitada Y, Arakawa M, Okamura H, Akiyoshi K, Hori D, Kimura N, Yamaguchi A. Impact of prosthesis-patient mismatch on late outcomes after bioprosthetic mitral valve replacement for mitral regurgitation. J Artif Organs 2021; 25:132-139. [PMID: 34665354 DOI: 10.1007/s10047-021-01299-9] [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: 05/24/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
Negative impact of prosthesis-patient mismatch on long-term survival after valve replacement has been reported. However, the effect of prosthesis-patient mismatch after bioprosthetic mitral valve replacement has not yet been well examined. The purpose of this study was to investigate the effect of prosthesis-patient mismatch on late outcomes after bioprosthetic mitral valve replacement for mitral regurgitation. A total of 181 patients underwent bioprosthetic mitral valve replacement between April 2008 and December 2016. After excluding patients with mitral stenosis and those with incomplete data, 128 patients were included in the study. Postoperative transthoracic echocardiography was performed before discharge for all patients and the effective orifice area of bioprosthetic mitral valve was calculated using the formula: 220/pressure half-time, and the effective orifice area index was calculated by the formula: effective orifice area/body surface area. Prosthesis-patient mismatch was defined as a postoperative effective orifice area index ≤ 1.2 cm2/m2. The characteristics and outcomes were compared between the groups. There were 34 patients (26.6%) with prosthesis-patient mismatch and 94 patients (73.4%) without prosthesis-patient mismatch. There were no significant differences in the in-hospital mortality and morbidities. Multivariable analysis showed that prosthesis-patient mismatch was an independent predictor of late mortality (hazard ratio 3.38; 95% confidence interval 1.69-6.75; p = 0.001) and death from heart failure (hazard ratio 31.03, 95% confidence interval 4.49-214.40, p < 0.001). Prosthesis-patient mismatch at discharge after mitral valve replacement for mitral regurgitation was associated with long-term mortality and death from heart failure.
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Affiliation(s)
- Yuichiro Kitada
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
| | - Mamoru Arakawa
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
| | - Kei Akiyoshi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan
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Takagi K, Arinaga K, Takaseya T, Otsuka H, Shojima T, Shintani Y, Kono T, Zaima Y, Kikusaki S, Saku K, Tayama E. Hemodynamic and clinical performance of the 25-mm Medtronic Mosaic porcine bioprosthesis in the mitral position. J Artif Organs 2021; 25:34-41. [PMID: 34023940 DOI: 10.1007/s10047-021-01277-1] [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: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
The 25-mm Medtronic Mosaic porcine bioprosthesis (MB25) is the smallest bioprosthesis that has been approved for use in the mitral position in Japan. Various studies have reported satisfactory hemodynamic performance and good long-term outcomes of the Medtronic Mosaic porcine bioprosthesis. However, the hemodynamic and clinical performances of the MB25 in the mitral position remain unknown. This study aimed to evaluate the hemodynamic and clinical performance of the MB25 in mitral valve replacement (MVR). Twenty patients who underwent MVR using the MB25 between February 2013 and April 2018 were studied. We evaluated the hemodynamic performance of the MB25, cardiac chamber size, cardiac function, and systolic pulmonary artery pressure (PAP) using echocardiography during follow-up. The study outcomes were major adverse cardiac events (MACEs) and all-cause mortality. Sixteen patients (80%) had a patient prosthesis mismatch defined as an index effective orifice area of ≤ 1.2 cm2/m2. The left atrial dimension was significantly reduced after surgery (p = 0.0282). The mean pressure gradients (MPG) in the mitral position were 5.5 ± 1.7 mmHg at discharge and 4.2 ± 1.3 mmHg at 1 year postoperatively. The MPG in the mitral position significantly decreased during the follow-up period (p = 0.0489). Systolic PAP significantly improved postoperatively. The 1-, 3-, and 5-year survival rates were 87, 79, and 70%, respectively. No cardiac death occurred. There were no MACEs or reports of structural valve degeneration during the follow-up period. The hemodynamic and clinical performances of the MB25 in the mitral position were satisfactory as the smallest biological mitral valve. The MB25 is a reasonable option for MVR to reduce the surgical difficulty in high-risk patients with an advanced age, a small body size or MAC and when recurrent MVR or complex procedures are performed.
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Affiliation(s)
- Kazuyoshi Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan.
| | - Koichi Arinaga
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Tohru Takaseya
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Hiroyuki Otsuka
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Takahiro Shojima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Yusuke Shintani
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Takanori Kono
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Yasuyuki Zaima
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Satoshi Kikusaki
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
| | - Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University, School of Medicine, 67 Asahimachi, Kurume, 830-0011, Japan
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Kono T, Takagi K, Saku K, Kikusaki S, Zaima Y, Shojima T, Takaseya T, Arinaga K, Tayama E. Evaluation of hemodynamics after mitral valve replacement with the St Jude Medical Epic bioprosthesis: a Japanese single-center experience. J Artif Organs 2021; 24:458-464. [PMID: 33770272 DOI: 10.1007/s10047-021-01262-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
To assess the early hemodynamics after mitral valve replacement (MVR) using the St Jude Medical (SJM) Epic bioprosthesis. MVR was performed using the SJM Epic bioprosthesis in 35 patients from June 2018 to April 2020; three patients were excluded because the postoperative transthoracic echocardiography (TTE) data were unavailable. Data from postoperative TTE at 1 week and 3 months after the procedure were reviewed. The mean mitral pressure gradient (mMPG) was calculated using a continuous wave Doppler method. Left ventricular outflow tract (LVOT) was calculated using a pulse wave Doppler method. The effective orifice area (EOA) was measured from pressure half time. There were 12 men (37.5%) and 20 women (62.5%) with a mean age of 75.9 years (61-88 years). The mean body surface area was 1.51 ± 0.22 cm2. The 25 mm and 27 mm valves were used in more than 50% of cases. The mMPG was 4.9 ± 1.7 mmHg and 5.4 ± 1.6 mmHg at 1 week and 3 months after surgery, respectively. EOA was 2.18 ± 0.50 cm2 and 2.31 ± 0.59 cm2 at 1 week and 3 months after surgery, respectively. The peak velocity of the LVOT (n = 22) was 103.3 ± 21.3 cm/s and 106.8 ± 27.4 cm/s at 1 week and 3 months after surgery, respectively. No findings suggested paravalvular regurgitation and LVOT obstruction. Using the SJM Epic bioprosthesis in MVR resulted in satisfactory hemodynamics in the early postoperative period, even with small valve sizes. Further accumulation of cases and evidence, including mid- to long-term results, is required in the future.
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Affiliation(s)
- Takanori Kono
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Satoshi Kikusaki
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasuyuki Zaima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takahiro Shojima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tohru Takaseya
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Arinaga
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Ali A, A. Shokka R, Mohammed R. Patient–valve mismatch: A comparison of mechanical versus biological prostheses in ischemic mitral patients undergoing chordal-sparing mitral valve replacement. JOURNAL OF MEDICINE IN SCIENTIFIC RESEARCH 2021. [DOI: 10.4103/jmisr.jmisr_85_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tomšič A, Arabkhani B, Schoones JW, Etnel JRG, Marsan NA, Klautz RJM, Palmen M. Prosthesis-patient mismatch after mitral valve replacement: A pooled meta-analysis of Kaplan-Meier-derived individual patient data. J Card Surg 2020; 35:3477-3485. [PMID: 33085138 PMCID: PMC7756724 DOI: 10.1111/jocs.15108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/26/2020] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
Objective The hemodynamic effect and early and late survival impact of prosthesis–patient mismatch (PPM) after mitral valve replacement remains insufficiently explored. Methods Pubmed, Embase, Web of Science, and Cochrane Library databases were searched for English language original publications. The search yielded 791 potentially relevant studies. The final review and analysis included 19 studies compromising 11,675 patients. Results Prosthetic effective orifice area was calculated with the continuity equation method in 7 (37%), pressure half‐time method in 2 (10%), and partially or fully obtained from referenced values in 10 (53%) studies. Risk factors for PPM included gender (male), diabetes mellitus, chronic renal disease, and the use of bioprostheses. When pooling unadjusted data, PPM was associated with higher perioperative (odds ratio [OR]: 1.66; 95% confidence interval [CI]: 1.32–2.10; p < .001) and late mortality (hazard ratio [HR]: 1.46; 95% CI: 1.21–1.77; p < .001). Moreover, PPM was associated with higher late mortality when Cox proportional‐hazards regression (HR: 1.97; 95% CI: 1.57–2.47; p < .001) and propensity score (HR: 1.99; 95% CI: 1.34–2.95; p < .001) adjusted data were pooled. Contrarily, moderate (HR: 1.01; 95% CI: 0.84–1.22; p = .88) or severe (HR: 1.19; 95% CI: 0.89–1.58; p = .24) PPM were not related to higher late mortality when adjusted data were pooled individually. PPM was associated with higher systolic pulmonary pressures (mean difference: 7.88 mmHg; 95% CI: 4.72–11.05; p < .001) and less pulmonary hypertension regression (OR: 5.78; 95% CI: 3.33–10.05; p < .001) late after surgery. Conclusions Mitral valve PPM is associated with higher postoperative pulmonary artery pressure and might impair perioperative and overall survival. The relation should be further assessed in properly designed studies.
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Affiliation(s)
- Anton Tomšič
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bardia Arabkhani
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nina A Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Tsubota H, Sakaguchi G, Arakaki R, Marui A. Impact of Prosthesis-Patient Mismatch After Mitral Valve Replacement: A Propensity Score Analysis. Semin Thorac Cardiovasc Surg 2020; 33:347-353. [PMID: 32971246 DOI: 10.1053/j.semtcvs.2020.09.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 11/11/2022]
Abstract
The effect of patient-prosthesis mismatch (PPM) on late outcomes after mitral valve replacement (MVR) remains unclear. We evaluated the impact of PPM after MVR on the late survival using propensity score matching analysis. From 2007 to 2018, 660 consecutive MVRs were performed. Effective orifice areas were obtained from a literature review of in vivo echocardiographic data, and mitral PPM was defined as an effective orifice area index of ≤1.2 cm2/m2. Propensity score matching yielded a cohort of 126 patients with PPM and 126 patients without PPM. Mitral PPM was found in 37.8% of the patients. In the whole matched patients, there were no differences in late survival (log-rank test, P = 0.629) between 2 groups. Patients aged ≤70 years and those aged >70 years had no differences in late survival (log-rank test, P = 0.073 and 0.572). The Cox proportional hazards model for the overall survival showed that mitral PPM tended to decrease survival in patients aged ≤70 years (P = 0.084, hazard ratio [HR] 2.647, 95% CI: 0.876-7.994). Mitral PPM did not adversely affect long-term survival. There may be a tendency of adverse impact on late survival in patients aged ≤70 years. Implanting a safe size rather than larger size prosthesis in mitral position may be an appropriate option in older patients.
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Affiliation(s)
- Hideki Tsubota
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Ryoko Arakaki
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
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Alkady H, Saber A, Abouramadan S, Elnaggar A, Nasr S, Mahmoud E. Mitral valve replacement in mitral stenosis; the problem of small left ventricle. J Cardiothorac Surg 2020; 15:67. [PMID: 32321541 PMCID: PMC7178577 DOI: 10.1186/s13019-020-01108-z] [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: 12/04/2019] [Accepted: 04/13/2020] [Indexed: 11/11/2022] Open
Abstract
Background Mitral valve stenosis in adults especially due to rheumatic heart disease may be associated with a smaller than normal left ventricular cavity. Mitral valve replacement in such cases may lead to hemodynamic instability either during weaning from cardiopulmonary bypass or in the early postoperative period manifested by the need for inotropic support and even mortality due to low cardiac output syndrome. Patients and methods 184 patients with predominately severe stenotic mitral valves who underwent elective isolated mitral valve replacement in the period between January 2012 and January 2018 at our hospital were included in this study. Patients were divided into 2 matched groups; (small LV group) consisting of 86 cases and (normal or dilated LV group) consisting of 98 cases. Results There were no statistically significant differences in operative details among both groups apart from the need for inotropic support and intra-aortic balloon pump due to low cardiac output which were statistically significantly higher in (small LV group) than (normal or dilated LV group) with a p-values of 0.01 and 0.03 respectively. Within the ICU stay only the incidence of occurrence of heart failure was significantly higher in (small LV group) with a p-value of 0.008. No statistically significant difference could be elicited in the in-hospital mortality between both groups (p-value = 0.1). Conclusion Patients with mitral valve stenosis and small left ventricular cavity are in a higher need for inotropic and even mechanical support after mitral valve replacement as well as at a higher risk for the development of heart failure before hospital discharge than patients with mitral stenosis and normal-sized left ventricular cavity.
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Affiliation(s)
- Hesham Alkady
- Department of cardiothoracic surgery, Cairo University, Kasralaini str., Almanial, Cairo, Egypt.
| | - Ahmed Saber
- Department of cardiothoracic surgery, Cairo University, Kasralaini str., Almanial, Cairo, Egypt
| | - Sobhy Abouramadan
- Department of cardiothoracic surgery, Cairo University, Kasralaini str., Almanial, Cairo, Egypt
| | - Ahmed Elnaggar
- Department of cardiothoracic surgery, Cairo University, Kasralaini str., Almanial, Cairo, Egypt
| | - Sherif Nasr
- Department of cardiothoracic surgery, Fayoum University, Fayoum, Egypt
| | - Eman Mahmoud
- Department of cardiology, Fayoum University, Fayoum, Egypt
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El Midany AA, Mostafa EA, Hikal T, Elbarbary MG, Doghish A, Khorshid R, Abdelgawad BM, Sharaa M, El-Sokkary IN, Hossiny ME, Abdelmoaty H, Elkhonezy BA. Incidence and predictors of mismatch after mechanical mitral valve replacement. Asian Cardiovasc Thorac Ann 2019; 27:535-541. [PMID: 31390876 DOI: 10.1177/0218492319869560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patient-prosthesis mismatch after mitral valve replacement has an unfavorable postoperative hemodynamic outcome, which underlines the importance of identifying and preventing prosthesis- and patient-related risk factors. This study was conducted to determine the incidence and identify possible predictors of patient-prosthesis mismatch. Methods A prospective study was conducted on 715 patients with a mean age of 42 ± 11 years who underwent mechanical mitral valve replacement between 2013 and 2017. The effective orifice area of the prostheses was estimated by the continuity equation, and a mismatch was defined as an effective orifice area index ≤1.2 cm2·m−2. The mean clinical and echocardiographic follow-up was 26.74 ± 11.58 months. Multivariate regression analysis was performed to identify predictors of patient-prosthesis mismatch. Results Patient-prosthesis mismatch was detected in 382 (53.4%) patients. A small mechanical prosthesis (<27 mm) was inserted in 54.3%. Mortality during follow-up was 9% (65 patients). Patient-prosthesis mismatch was identified in patients with preoperative rheumatic mitral valve pathology, associated tricuspid regurgitation, higher New York Heart Association class, preoperative atrial fibrillation, mitral stenosis, and small preoperative left ventricular dimensions. Multivariate analysis identified mitral stenosis, preoperative atrial fibrillation, and small postoperative left ventricular end-diastolic dimension as risk factors for patient-prosthesis mismatch. Conclusion Patient-prosthesis mismatch is a common sequela after mechanical mitral valve replacement. Identification of predictors of patient-prosthesis mismatch can help so that a preoperative strategy can be implemented to avoid its occurrence.
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Affiliation(s)
- Ashraf Ah El Midany
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Ezzeldin A Mostafa
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Tamer Hikal
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Mostafa G Elbarbary
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Ayman Doghish
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Ramy Khorshid
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Basem M Abdelgawad
- 2 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
| | - Mohamed Sharaa
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ismail N El-Sokkary
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed El Hossiny
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Haytham Abdelmoaty
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Bahaa A Elkhonezy
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Sá MPBO, Cavalcanti LRP, Rayol SDC, Diniz RGS, Menezes AM, Clavel MA, Pibarot P, Lima RC. Prosthesis-Patient Mismatch Negatively Affects Outcomes after Mitral Valve Replacement: Meta-Analysis of 10,239 Patients. Braz J Cardiovasc Surg 2019; 34:203-212. [PMID: 30916131 PMCID: PMC6436788 DOI: 10.21470/1678-9741-2019-0069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study sought to evaluate the impact of prosthesis-patient mismatch on the risk of perioperative and long-term mortality after mitral valve replacement. METHODS Databases were researched for studies published until December 2018. Main outcomes of interest were perioperative and 10-year mortality and echocardiographic parameters. RESULTS The research yielded 2,985 studies for inclusion. Of these, 16 articles were analyzed, and their data extracted. The total number of patients included was 10,239, who underwent mitral valve replacement. The incidence of prosthesis-patient mismatch after mitral valve replacement was 53.7% (5,499 with prosthesis-patient mismatch and 4,740 without prosthesis-patient mismatch). Perioperative (OR 1.519; 95%CI 1.194-1.931, P<0.001) and 10-year (OR 1.515; 95%CI 1.280-1.795, P<0.001) mortality was increased in patients with prosthesis-patient mismatch. Patients with prosthesis-patient mismatch after mitral valve replacement had higher systolic pulmonary artery pressure and transprosthethic gradient and lower indexed effective orifice area and left ventricle ejection fraction. CONCLUSION Prosthesis-patient mismatch increases perioperative and long-term mortality. Prosthesis-patient mismatch is also associated with pulmonary hypertension and depressed left ventricle systolic function. The findings of this study support the implementation of surgical strategies to prevent prosthesis-patient mismatch in order to decrease mortality rates.
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Affiliation(s)
- Michel Pompeu Barros Oliveira Sá
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil.,Nucleus of Postgraduate Studies and Research in Health Sciences at Faculdade de Ciências Médicas and Instituto de Ciências Biológicas (FCM/ICB), Recife, PE, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Sérgio da Costa Rayol
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Roberto Gouvea Silva Diniz
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Alexandre Motta Menezes
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | | | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie du Québec, Canada
| | - Ricardo Carvalho Lima
- Department of Cardiovascular Surgery at the Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco (UPE), Recife, PE, Brazil.,Nucleus of Postgraduate Studies and Research in Health Sciences at Faculdade de Ciências Médicas and Instituto de Ciências Biológicas (FCM/ICB), Recife, PE, Brazil
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10
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Akuffu AM, Zhao H, Zheng J, Ni Y. Prosthesis-patient mismatch after mitral valve replacement: a single-centered retrospective analysis in East China. J Cardiothorac Surg 2018; 13:100. [PMID: 30285794 PMCID: PMC6169081 DOI: 10.1186/s13019-018-0788-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/25/2018] [Indexed: 11/30/2022] Open
Abstract
Background Prosthesis–patient mismatch (PPM) may affect the clinical outcomes of patients undergoing mitral valve replacement (MVR) surgery. We aimed to investigate the incidence of PPM of the mitral position in our center and analyze the possible predictors of PPM as well as its effect on short-term outcomes. Methods We retrospectively examined all consecutive patients with isolated or concomitant MVR at our center from 2013 to 2015. PPM was defined as an indexed effective orifice area (iEOA) of ≤1.2 cm2/m2. After inclusion and exclusion, a total of 1067 patients were analyzed. The baseline information were collected and compared between the two groups. Multivariate logistic regression analysis was conducted to determine the preoperative predictors of PPM as well as the effect of PPM on early mortality. Results A total of 1067 patients were included in the study. PPM was detected in 15.9% of the patients while 12 patients (1.12%) met the criteria for severe PPM. Patients with PPM compared to the non-PPM patients had higher age, larger body surface area and were more likely to be male and obese. Logistic regression analysis showed that higher age, larger BSA, bioprosthesis and smaller left ventricle end-diastolic diameter were predictors of PPM. There were no significant differences between the PPM and non-PPM groups regarding post-operative complications. Logistic regression analysis showed that PPM was not a risk factor of short-term mortality (P = 0.654). Also, there were no significant differences regarding short−/mid-term heart function between the PPM and non PPM groups (P = 0.902). Conclusions Our results demonstrated that higher age, bioprosthesis, larger BSA and smaller left ventricle size were associated with mitral PPM. However, PPM was not associated with poorer early outcomes after MVR surgery. In eastern of China, the prevalence of mitral valve stenosis is high; therefore, whether the standard PPM criteria are suitable for patients of this district needs to be further verified.
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Affiliation(s)
- Armah M Akuffu
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Haige Zhao
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, China
| | - Junnan Zheng
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, China.
| | - Yiming Ni
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, China
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Barac YD, Zwischenberger B, Schroder JN, Daneshmand MA, Haney JC, Gaca JG, Wang A, Milano CA, Glower DD. Using a Regent Aortic Valve in a Small Annulus Mitral Position Is a Viable Option. Ann Thorac Surg 2017; 105:1200-1204. [PMID: 29258732 DOI: 10.1016/j.athoracsur.2017.11.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Outcome of mitral valve replacement in extreme scenarios of small mitral annulus with the use of the Regent mechanical aortic valve is not well documented. METHODS Records were examined in 31 consecutive patients who underwent mitral valve replacement with the use of the aortic Regent valve because of a small mitral annulus. RESULTS Mean age was 60 ± 14 years. Mitral stenosis or mitral annulus calcification was present in 30 of 31 patients (97%). Concurrent procedures were performed in 17 of 31 patients (55%). Median valve size was 23 mm. Mean mitral gradient coming out of the operating room was 4.2 ± 1.5 mm Hg and at follow-up echocardiogram performed at a median of 32 months after the procedure was 5.8 ± 2.4 mm Hg. CONCLUSIONS A Regent aortic mechanical valve can be a viable option with a larger orifice area than the regular mechanical mitral valve in a problematic situation of a small mitral valve annulus. Moreover, the pressure gradients over the valve are acceptable intraoperatively and over time.
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Affiliation(s)
- Yaron D Barac
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Jacob N Schroder
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mani A Daneshmand
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - John C Haney
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey G Gaca
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Andrew Wang
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Carmelo A Milano
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Donald D Glower
- Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
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