Circulation. 2003;108:983-988
Published online before print August 11, 2003, doi: 10.1161/01.CIR.0000085167.67105.32
Published online before print August 11, 2003, doi: 10.1161/01.CIR.0000085167.67105.32
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(Circulation. 2003;108:983.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement
From the Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada.
Correspondence to Dr Pibarot, Quebec Heart Institute, 2725 Chemin Sainte-Foy, Sainte-Foy G1V-4G5, Quebec, Canada. E-mail philippe.pibarot{at}med.ulaval.ca
Received September 13, 2002; de novo received April 24, 2003; revision received June 2, 2003; accepted June 4, 2003.
Background— The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. This study examined if there is a relation between PPM and short-term mortality after operation.
Methods and Results— The indexed valve effective orifice area (EOA) was estimated for each type and size of prosthesis being implanted in 1266 consecutive patients and used to define PPM as not clinically significant if >0.85 cm2/m2, as moderate if >0.65 cm2/m2 and 
0.85 cm2/m2, and as severe if 0.65 cm2/m2; it was correlated with 30-day mortality and compared with other relevant variables. Moderate or severe PPM was present in 38% of patients. Thirty-day mortality was 4.6% (58/1266 patients) and the strongest independent predictors in multivariate analysis were left ventricular ejection fraction <40% (P=0.007), infectious endocarditis (P=0.002), emergent/salvage operation (P=0.002), cardiopulmonary bypass time >120 minutes (P=0.001), and PPM (P=0.003). Relative risk of mortality was increased 2.1-fold (95% confidence interval, 1.2 to 3.7) in patients with moderate PPM and 11.4-fold (4.4 to 29.5) in those with severe PPM. Moreover, risk of mortality for every category of PPM was higher in patients with a left ventricular ejection fraction <40% as compared with 
40% (nonsignificant PPM, 2.7 versus 1.0; moderate PPM, 7.1 versus 1.8; severe PPM, 77.1 versus 11.3).
Conclusion— PPM is a strong and independent predictor of short-term mortality among patients undergoing AVR, and its impact is related both to its degree of severity and the status of left ventricular function. In contrast to other risk factors, moderate-severe PPM can be largely avoided with the use of a prospective strategy at the time of operation.
Key Words: valves • prosthesis • mortality • hemodynamics
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D. Mohty-Echahidi, J. F. Malouf, S. E. Girard, H. V. Schaff, D. E. Grill, M. E. Enriquez-Sarano, and F. A. Miller Jr Impact of Prosthesis-Patient Mismatch on Long-Term Survival in Patients With Small St Jude Medical Mechanical Prostheses in the Aortic Position Circulation, January 24, 2006; 113(3): 420 - 426. [Abstract] [Full Text] [PDF]
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P. Pibarot, J. G. Dumesnil, G. Tasca, C. G. Koch, F. Khandwala, F. G. Estafanous, F. D. Loop, and E. H. Blackstone Letter Regarding Article by Koch et al, "Impact of Prothesis-Patient Size on Functional Recovery After Aortic Valve Replacement" * Response Circulation, November 22, 2005; 112(21): e333 - e333. [Full Text] [PDF]
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D. Perez de Arenaza, B. Lees, M. Flather, F. Nugara, T. Husebye, M. Jasinski, M. Cisowski, M. Khan, M. Henein, J. Gaer, et al. Randomized Comparison of Stentless Versus Stented Valves for Aortic Stenosis: Effects on Left Ventricular Mass Circulation, October 25, 2005; 112(17): 2696 - 2702. [Abstract] [Full Text] [PDF]
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R. Guenzinger, W. B. Eichinger, F. Botzenhardt, S. Bleiziffer, I. Wagner, R. Bauernschmitt, S. M. Wildhirt, and R. Lange Rest and Exercise Performance of the Medtronic Advantage Bileaflet Valve in the Aortic Position Ann. Thorac. Surg., October 1, 2005; 80(4): 1319 - 1326. [Abstract] [Full Text] [PDF]
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M. D. Maganti, V. Rao, M. A. Borger, J. Ivanov, and T. E. David Predictors of Low Cardiac Output Syndrome After Isolated Aortic Valve Surgery Circulation, August 30, 2005; 112(9_suppl): I-448 - I-452. [Abstract] [Full Text] [PDF]
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J. Odim, H. Laks, V. Allada, J. Child, S. Wilson, and D. Gjertson Results of Aortic Valve-Sparing and Restoration With Autologous Pericardial Leaflet Extensions in Congenital Heart Disease Ann. Thorac. Surg., August 1, 2005; 80(2): 647 - 654. [Abstract] [Full Text] [PDF]
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M. Briand, J. G. Dumesnil, L. Kadem, A. G. Tongue, R. Rieu, D. Garcia, and P. Pibarot Reduced Systemic Arterial Compliance Impacts Significantly on Left Ventricular Afterload and Function in Aortic Stenosis: Implications for Diagnosis and Treatment J. Am. Coll. Cardiol., July 19, 2005; 46(2): 291 - 298. [Abstract] [Full Text] [PDF]
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F. Botzenhardt, W. B. Eichinger, S. Bleiziffer, R. Guenzinger, I. M. Wagner, R. Bauernschmitt, and R. Lange Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic Annulus J. Am. Coll. Cardiol., June 21, 2005; 45(12): 2054 - 2060. [Abstract] [Full Text] [PDF]
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T. E. David Is Prosthesis-Patient Mismatch a Clinically Relevant Entity? Circulation, June 21, 2005; 111(24): 3186 - 3187. [Full Text] [PDF]
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C. G. Koch, F. Khandwala, F. G. Estafanous, F. D. Loop, and E. H. Blackstone Impact of Prosthesis-Patient Size on Functional Recovery After Aortic Valve Replacement Circulation, June 21, 2005; 111(24): 3221 - 3229. [Abstract] [Full Text] [PDF]
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A. Penta de Peppo, J. Zeitani, P. Nardi, G. Iaci, P. Polisca, R. De Paulis, and L. Chiariello Small "Functional" Size after Mechanical Aortic Valve Replacement: No Risk in Young to Middle-Age Patients Ann. Thorac. Surg., June 1, 2005; 79(6): 1915 - 1920. [Abstract] [Full Text] [PDF]
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F. Dagenais, P. Cartier, P. Voisine, D. Desaulniers, J. Perron, R. Baillot, G. Raymond, J. Metras, D. Doyle, and P. Mathieu Which biologic valve should we select for the 45- to 65-year-old age group requiring aortic valve replacement? J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1041 - 1049. [Abstract] [Full Text] [PDF]
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W. B. Eichinger, F. Botzenhardt, A. Keithahn, R. Guenzinger, S. Bleiziffer, I. Wagner, R. Bauernschmitt, and R. Lange Exercise hemodynamics of bovine versus porcine bioprostheses: A prospective randomized comparison of the mosaic and perimount aortic valves J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1056 - 1063. [Abstract] [Full Text] [PDF]
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M. Li, J. G. Dumesnil, P. Mathieu, and P. Pibarot Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1034 - 1040. [Abstract] [Full Text] [PDF]
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E. Otero, J. L. Pomar, J. M. Revuelta, and J. J. Rufilanchas Comparative Evaluation of Small-Size Sorin Slimline and St. Jude HP Heart Valve Prostheses Ann. Thorac. Surg., April 1, 2005; 79(4): 1284 - 1290. [Abstract] [Full Text] [PDF]
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R. G. Fuster, J. A. M. Argudo, O. G. Albarova, F. H. Sos, S. C. Lopez, M. B. Codoner, J. A. B. Minano, and I. R. Albarran Patient-prosthesis mismatch in aortic valve replacement: really tolerable? Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 441 - 449. [Abstract] [Full Text] [PDF]
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C. Amarelli, A. Della Corte, G. Romano, G. Iasevoli, G. Dialetto, L. S. De Santo, M. De Feo, M. Torella, M. Scardone, and M. Cotrufo Left ventricular mass regression after aortic valve replacement with 17-mm St Jude Medical mechanical prostheses in isolated aortic stenosis J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 512 - 517. [Abstract] [Full Text] [PDF]
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G. Tasca, F. Brunelli, M. Cirillo, M. DallaTomba, Z. Mhagna, G. Troise, and E. Quaini Impact of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement Ann. Thorac. Surg., February 1, 2005; 79(2): 505 - 510. [Abstract] [Full Text] [PDF]
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G. P. Aurigemma and W. H. Gaasch Low flow-low gradient aortic stenosis: The pathologist weighs in J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1856 - 1858. [Full Text] [PDF]
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T. Walther, S. Lehmann, V. Falk, S. Metz, N. Doll, A. Rastan, M. Viehweg, M. Richter, J. Gummert, and F. W. Mohr Prospectively Randomized Evaluation of Stented Xenograft Hemodynamic Function in the Aortic Position Circulation, September 14, 2004; 110(11_suppl_1): II-74 - II-78. [Abstract] [Full Text] [PDF]
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D. S. Bach, N. D. Kon, J. G. Dumesnil, C. F. Sintek, and D. B. Doty Eight-year results after aortic valve replacement with the Freestyle stentless bioprosthesis J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1657 - 1663. [Abstract] [Full Text] [PDF]
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J. G. Dumesnil and P. Pibarot Prosthesis size and prosthesis-patient size are unrelated to prosthesis-patient mismatch J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1852 - 1852. [Full Text] [PDF]
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E. H. Blackstone, A. M. Gillinov, and D. M. Cosgrove Reply to the Editor J. Thorac. Cardiovasc. Surg., June 1, 2004; 127(6): 1852 - 1854. [Full Text] [PDF]
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A. Weerasinghe, M. Yusuf, T. Athanasiou, A. Wood, P. Magee, and R. Uppal Role of transvalvular gradient in outcome from valve replacement for aortic stenosis Ann. Thorac. Surg., April 1, 2004; 77(4): 1266 - 1271. [Abstract] [Full Text] [PDF]
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R. SoRelle Cardiovascular News Circulation, August 26, 2003; 108 (8): e9014 - e9015. [Full Text]
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