Published online before print January 16, 2006, doi: 10.1161/CIRCULATIONAHA.105.546754
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;113:420-426.)
© 2006 American Heart Association, Inc.
Valvular Heart Disease |
Impact of Prosthesis-Patient Mismatch on Long-Term Survival in Patients With Small St Jude Medical Mechanical Prostheses in the Aortic Position
From the Division of Cardiovascular Diseases (D.M.-E., J.F.M., S.E.G., M.E.E.-S., F.A.M.), the Division of Cardiovascular Surgery (H.V.S.), and the Division of Biostatistics (D.E.G.), Mayo Clinic, Rochester, Minn.
Reprint requests to Fletcher A. Miller, Jr, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905. E-mail miller.fletcher{at}mayo.edu
Received March 2, 2005; revision received October 20, 2005; accepted October 27, 2005.
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 cm2/m2), moderate (0.60 cm2/m2<indexed EOA0.85 cm2/m2), or not hemodynamically significant (indexed EOA >0.85 cm2/m2). 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.
CLINICAL PERSPECTIVE
This article has been cited by other articles:
 |
|
 |
|
  R. M. Suri, K. J. Zehr, T. M. Sundt III, J. A. Dearani, R. C. Daly, J. K. Oh, and H. V. Schaff Left ventricular mass regression after porcine versus bovine aortic valve replacement: a randomized comparison. Ann. Thorac. Surg., October 1, 2009; 88(4): 1232 - 1237. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. A. Mannacio, V. De Amicis, L. Di Tommaso, F. Iorio, and C. Vosa Influence of prosthesis-patient mismatch on exercise-induced arrhythmias: a further aspect after aortic valve replacement. J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 632 - 638. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Price, H. Lapierre, L. Ressler, B.-K. Lam, T. G. Mesana, and M. Ruel Prosthesis-patient mismatch is less frequent and more clinically indolent in patients operated for aortic insufficiency. J. Thorac. Cardiovasc. Surg., September 1, 2009; 138(3): 639 - 645. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Urso, R. Sadaba, and G. Aldamiz-Echevarria Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement? Interactive CardioVascular and Thoracic Surgery, September 1, 2009; 9(3): 510 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-L. Monin Prosthesis-patient mismatch: myth or reality? Heart, June 1, 2009; 95(11): 948 - 952. [Full Text] [PDF]
|
|
|
|
 |
|
 M.-A. Clavel, J. G. Webb, P. Pibarot, L. Altwegg, E. Dumont, C. Thompson, R. De Larochelliere, D. Doyle, J.-B. Masson, S. Bergeron, et al. Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis J. Am. Coll. Cardiol., May 19, 2009; 53(20): 1883 - 1891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.R. E. Jamieson, E. Germann, J. Ye, F. Chan, A. Cheung, J. S. MacNab, G. J. Fradet, E. A. Stanford, L. A. Bryson, and S. V. Lichtenstein Effect of Prosthesis-Patient Mismatch on Long-Term Survival With Mitral Valve Replacement: Assessment to 15 Years Ann. Thorac. Surg., April 1, 2009; 87(4): 1135 - 1142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J G Dumesnil, J Magne, N Girerd, and P Pibarot Moderate patient-prosthesis mismatch can impact on mortality after aortic valve replacement Heart, April 1, 2009; 95(7): 592 - 592. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Pibarot and J. G. Dumesnil Prosthetic Heart Valves: Selection of the Optimal Prosthesis and Long-Term Management Circulation, February 24, 2009; 119(7): 1034 - 1048. [Full Text] [PDF]
|
|
|
|
|
|
M. R. Moon, J. S. Lawton, N. Moazami, N. A. Munfakh, M. K. Pasque, and R. J. Damiano Jr. POINT: Prosthesis-patient mismatch does not affect survival for patients greater than 70 years of age undergoing bioprosthetic aortic valve replacement. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 278 - 283. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mohty, J. G. Dumesnil, N. Echahidi, P. Mathieu, F. Dagenais, P. Voisine, and P. Pibarot Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesity, and left ventricular dysfunction. J. Am. Coll. Cardiol., January 6, 2009; 53(1): 39 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Vicchio, A. Della Corte, L. S. De Santo, M. De Feo, G. Caianiello, M. Scardone, and M. Cotrufo Prosthesis-Patient Mismatch in the Elderly: Survival, Ventricular Mass Regression, and Quality of Life Ann. Thorac. Surg., December 1, 2008; 86(6): 1791 - 1797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Mascherbauer, R Rosenhek, C Fuchs, E Pernicka, U Klaar, C Scholten, M Heger, G Wollenek, G Maurer, and H Baumgartner Moderate patient-prosthesis mismatch after valve replacement for severe aortic stenosis has no impact on short-term and long-term mortality Heart, December 1, 2008; 94(12): 1639 - 1645. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Chambers, R. Rajani, D. Parkin, H. M. Rimington, C. I. Blauth, G. E. Venn, C. P. Young, and J. C. Roxburgh Bovine pericardial versus porcine stented replacement aortic valves: Early results of a randomized comparison of the Perimount and the Mosaic valves. J. Thorac. Cardiovasc. Surg., November 1, 2008; 136(5): 1142 - 1148. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. T.L. Chiam and C. E. Ruiz Percutaneous Transcatheter Aortic Valve Implantation: Assessing Results, Judging Outcomes, and Planning Trials: The Interventionalist Perspective J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 341 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kohsaka, S. Mohan, S. Virani, V.-V. Lee, A. Contreras, G. J. Reul, and S. A. Coulter Prosthesis-patient mismatch affects long-term survival after mechanical valve replacement. J. Thorac. Cardiovasc. Surg., May 1, 2008; 135(5): 1076 - 1080. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Bleiziffer, W B Eichinger, I Hettich, D Ruzicka, M Wottke, R Bauernschmitt, and R Lange Impact of patient-prosthesis mismatch on exercise capacity in patients after bioprosthetic aortic valve replacement Heart, May 1, 2008; 94(5): 637 - 641. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Dumesnil and P. Pibarot Invited Commentary Ann. Thorac. Surg., April 1, 2008; 85(4): 1308 - 1309. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]
|
|
|
|
 |
|
 J.-L. Monin, M. Monchi, M. E.W. Kirsch, H. Petit-Eisenmann, S. Baleynaud, C. Chauvel, D. Metz, C. Adams, J.-P. Quere, P. Gueret, et al. Low-gradient aortic stenosis: impact of prosthesis-patient mismatch on survival Eur. Heart J., November 1, 2007; 28(21): 2620 - 2626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Dhareshwar, T. M. Sundt III, J. A. Dearani, H. V. Schaff, D. J. Cook, and T. A. Orszulak Aortic root enlargement: What are the operative risks? J. Thorac. Cardiovasc. Surg., October 1, 2007; 134(4): 916 - 924. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Garcia Fuster, V. Estevez, I. Rodriguez, S. Canovas, O. Gil, F. Hornero, and J. Martinez-Leon Prosthesis patient mismatch with latest generation supra-annular prostheses. The beginning of the end? Interactive CardioVascular and Thoracic Surgery, August 1, 2007; 6(4): 462 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Peterson, M. A. Borger, C. M. Feindel, and T. E. David Aortic Annular Enlargement During Aortic Valve Replacement: Improving Results With Time Ann. Thorac. Surg., June 1, 2007; 83(6): 2044 - 2049. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Pibarot and J. G. Dumesnil Prosthesis-patient mismatch in the mitral position: Old concept, new evidences J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1405 - 1408. [Full Text] [PDF]
|
|
|
|
|
|
B.-K. Lam, V. Chan, P. Hendry, M. Ruel, R. Masters, P. Bedard, B. Goldstein, F. Rubens, and T. Mesana The impact of patient-prosthesis mismatch on late outcomes after mitral valve replacement J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1464 - 1473. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Wagner, W. B. Eichinger, S. Bleiziffer, F. Botzenhardt, I. Gebauer, R. Guenzinger, R. Bauernschmitt, and R. Lange Influence of completely supra-annular placement of bioprostheses on exercise hemodynamics in patients with a small aortic annulus J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1234 - 1241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Pibarot and J. G Dumesnil Prevention of valve prosthesis--patient mismatch before aortic valve replacement: does it matter and is it feasible? Heart, May 1, 2007; 93(5): 549 - 551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bleiziffer, W. B Eichinger, I. Hettich, R. Guenzinger, D. Ruzicka, R. Bauernschmitt, and R. Lange Prediction of valve prosthesis-patient mismatch prior to aortic valve replacement: which is the best method? Heart, May 1, 2007; 93(5): 615 - 620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Bridges, S. M. O'Brien, J. C. Cleveland, E. B. Savage, J. S. Gammie, F. H. Edwards, E. D. Peterson, and F. L. Grover Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 1012 - 1021. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Magne, P. Mathieu, J. G. Dumesnil, D. Tanne, F. Dagenais, D. Doyle, and P. Pibarot Impact of Prosthesis-Patient Mismatch on Survival After Mitral Valve Replacement Circulation, March 20, 2007; 115(11): 1417 - 1425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bleiziffer, W. B. Eichinger, and R. Lange Letter by Bleiziffer et al Regarding Article, "Long-Term Outcomes After Valve Replacement for Low-Gradient Aortic Stenosis: Impact of Prosthesis-Patient Mismatch" Circulation, December 5, 2006; 114(23): e627 - e627. [Full Text] [PDF]
|
|
|
|
|
|
P Pibarot and J G Dumesnil Prosthesis-patient mismatch: definition, clinical impact, and prevention Heart, August 1, 2006; 92(8): 1022 - 1029. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H. Rahimtoola Is severe valve prosthesis-patient mismatch (VP-PM) associated with a higher mortality? Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 1 - 1. [Full Text] [PDF]
|
|
|
|
|
|
J. G. Dumesnil and P. Pibarot Prosthesis-patient mismatch and clinical outcomes: The evidence continues to accumulate J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 952 - 955. [Full Text] [PDF]
|
|