1
|
Patient–Prosthesis Mismatch in Contemporary Small-Size Mechanical Prostheses Does Not Impact Survival at 10 Years. J Cardiovasc Dev Dis 2022; 9:jcdd9020048. [PMID: 35200701 PMCID: PMC8877093 DOI: 10.3390/jcdd9020048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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.
Collapse
|
2
|
Aitaliyev S, Rumbinaitė E, Mėlinytė-Ankudavičė K, Nekrošius R, Keturakis V, Benetis R. Early outcomes of patient-prosthesis mismatch following aortic valve replacement. Perfusion 2021; 37:692-699. [PMID: 34080457 PMCID: PMC9500169 DOI: 10.1177/02676591211023286] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patient-prosthesis mismatch (PPM) has been associated with numerous short- and long-term adverse events. This study aimed to evaluate the effect of PPM on early postoperative results after aortic valve replacement (AVR) in daily practice. METHODS In this single-centre retrospective study, 150 non-consecutive patients from March 2019 to January 2020 with clinically indicated AVR with/without concomitant surgery were analysed. The study protocol included operative mortality, complication rate, and pre- and postoperative echocardiographic data. PPM was considered severe with indexed effective orifice area at <0.65 cm2/m2, moderate at 0.65-0.85 cm2/m2 and none at >0.85 cm2/m2. RESULTS Moderate PPM was observed in 16 patients (10.6%). No patient had severe PPM. PPM was not related to early mortality (r = 0.40, p = 0.630), intra- (r = -0.076, p = 0.352) and postoperative (r = -0.0134, p = 0.102) events. CONCLUSION In this study, moderate PPM was a frequent finding after AVR, whereas severe PPM was not observed. PPM did not affect the early results after AVR. A long-term follow-up study in a large patient population is required to assess the actual influence of residual PPM.
Collapse
Affiliation(s)
- Serik Aitaliyev
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Egle Rumbinaitė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Rokas Nekrošius
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytenis Keturakis
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
3
|
Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis. J Clin Med 2021; 10:jcm10102055. [PMID: 34064845 PMCID: PMC8151595 DOI: 10.3390/jcm10102055] [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: 03/02/2021] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The long-term performance of prostheses in the small aortic root is still unclear. Methods: Patients who received a 21 mm or smaller aortic valve between 2000–2018 were retrospectively analyzed. Propensity matching was used in order to account for baseline differences in 19 mm vs. 21 mm valve subgroups. Results: Survival at 10 years was 55.87 ± 5.54% for 19 mm valves vs. 57.17 ± 2.82% for 21 mm ones in the original cohort (p = 0.37), and 58.69 ± 5.61% in 19 mm valve recipients vs. 53.60 ± 5.66% for 21 mm valve subgroups in the matched cohort (p = 0.55). Smaller valves exhibited significantly more patient–prothesis mismatch (PPM) than larger ones (87.30% vs. 57.94%, p < 0.01). All-cause mortality was affected by PPM at 10 years (52.66 ± 3.28% vs. 64.38 ± 3.87%, p = 0.04) in the unmatched population. This difference disappeared, however, after matching: survival at 10 years was 51.82 ± 5.26% in patients with PPM and 63.12 ± 6.43% in patients without PPM. (p = 0.14) Conclusions: There is no survival penalty in using 19 mm prostheses in the small aortic root in the current era. Although PPM is more prevalent in smaller sized valve recipients, this does not translate into reduced survival at 10 years of follow-up.
Collapse
|
4
|
Aggarwal N, Gadhinglajkar SV, Panicker VT, Sreedhar R, Babu S, Mathew DG, Prasannakumar CS. Posterior Aortic Root Enlargement During Aortic Valve Replacement: Role of Intraoperative Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2017; 31:1312-1317. [PMID: 28596055 DOI: 10.1053/j.jvca.2017.02.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Neelam Aggarwal
- Department of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Science and Technology, Kerala, India
| | - Shrinivas V Gadhinglajkar
- Department of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Science and Technology, Kerala, India.
| | - Varghese T Panicker
- Department of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
| | - Rupa Sreedhar
- Department of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Science and Technology, Kerala, India
| | - Saravana Babu
- Department of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Science and Technology, Kerala, India
| | - Deepak Gregory Mathew
- Department of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Science and Technology, Kerala, India
| | - Chirag S Prasannakumar
- Department of Cardiac Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
| |
Collapse
|
5
|
Early and Mid-term Outcome of the St. Jude Medical Regent 19-mm Aortic Valve Mechanical Prosthesis. Functional and Haemodynamic Evaluation. Heart Lung Circ 2017; 27:235-247. [PMID: 28400190 DOI: 10.1016/j.hlc.2017.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 01/23/2017] [Accepted: 02/14/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of the present study is to report the early and mid-term clinical and haemodynamic results of the St Jude Medical Regent 19-mm aortic mechanical prothesis (SJMR-19). MATERIALS AND METHODS Between January 2002 and January 2012, 265 patients with aortic valve disease underwent AVR (Aortic Valve Replacement) with a SJMR-19 (St Jude Medical Regent Nr.19). There were 51 males. Mean age was 67.5±12.72years and mean body surface area (BSA) was 1.67±0.14m2. Thirty-six patients required annulus enlargement. The mean follow-up was 34.5±18.8months (range 6-60 months). All patients underwent echocardiographic examination at discharge and within 1 year after surgery. RESULTS There were 14 (5.3%) hospital deaths. Six of the hospital deaths were identified in patients undergoing reoperation, significantly higher than patients undergoing first time operation (p=0.0001). Also the postoperative mortality was significantly higher in patients undergoing annulus enlargement versus patients not requiring annulus enlargement (p=0.02). The mean transprosthesis gradient at discharge was 19±9mmHg. At 6 months follow-up the mean NYHA FC class was 1.6±0.5 significantly lower than preoperatively 2.4±0.75 (p <0.0001). The M-TPG was 15.2±6.5mmHg within 1 year after surgery. Left ventricular mass (LVM) and indexed left ventricular mass (LVMi) were significantly lower than preoperatively The actuarial survival and cumulative freedom from reoperation at 1, 2 and 3 years follow-up were 99.5%, 97.5%, 96.7% and 99.2%, 96.5%, 94.5% respectively. The cumulative actuarial free-events survival at 4 years was 92%. The Cox model identified age (p=0.015), LVEF≤35% (p=0.043), reoperation (p=0.031), combined surgery (p=0.00002), and annulus enlargement (p=0.015) as strong predictors for poor actuarial free-major events survival. CONCLUSIONS The SJMR-19 offers excellent postoperative clinical, haemodynamic outcome and LVMi reduction in patients with small aortic annulus. These data demonstrate that the modern St Jude small mechanical protheses do not influence the intermediate free-reoperation survival.
Collapse
|
6
|
Prifti E, Bonacchi M, Ademaj F, Giunti G, Esposito G, Baboci A, Bajraktari G, Veshti A, Demiraj A, Vanini V. Early and mid-term outcome in terms of functional and hemodynamic performance of the st. Jude regent 19-mm aortic mechanical prosthesis versus 19-mm carpentier edwards aortic biological prosthesis. J Cardiothorac Surg 2015; 10:154. [PMID: 26541289 PMCID: PMC4635601 DOI: 10.1186/s13019-015-0361-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 10/28/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The aim of the present study is to compare the early and mid-term clinical and hemodynamic results of the aortic valve replacement (AVR) with a St Jude Medical Regent 19-mm prosthesis (SJMR-19) versus Carpentied-Edwars bovine pericardial 19-mm valve (CE-19). METHODS Between January 2002 and January 2012, 265 patients (Group I) and 58 patients (Group II) with underwent AVR with a SJMR-19 and CE-19 respectively. There were no significant differences between groups regarding the demographic and preoperative echocardiographic data. Thirty-six patients in Group I and 4 in Group II required annulus enlargement in association or not with septal myectomy. The mean follow-up was 34 ± 18.5 months (range 5-60 months). RESULTS There were 14 (5.3 %) hospital deaths in Group I versus 4 (6.8 %) in Group II (p = 0.86). The multivariate logistic regression analysis identified the LVEF ≤ 35 % (p = 0.001), combined operation (p = 0.0005), CPB (p = 0.033), age (p = 0.011), annulus enlargement (p = 0.0009), reoperation (p = 0.039) and chronic renal failure (p = 0.011) as strong predictors for early postoperative death. Within 1 year after surgery peak pulmonary artery pressure, interventricular septal and left ventricular posterior wall thickness decreased significantly in both groups. The M-TPG was 15.7 ± 6.5 mmHg in Group I versus 17 ± 7 mmHg in Group II (p = 0.19). The multivariate regression analysis revealed the annulus enlargement (p = 0.018), small EOAi (p = 0.00004), postoperative LVMi (p = 0.0001) and BSA (p = 0.019) as strong predictors for higher M-TPG. The postoperative LVMi was 119 ± 22.5 gm/m(2) in Group I and 122 ± 22 gm/m(2) in Group II (p = 0.37), significantly lower than the respective preoperative values 162.5 ± 34 gm/m(2) (Group I) and 168 ± 30 gm/m(2) (Group II). The actuarial survival and cumulative free-reoperation actuarial survival at 5 years follow-up were 96.7 and 94.5 % respectively in Group I and 97 and 91 % in Group II.. There were non significant differences between groups regarding the actuarial survival and cumulative free-reoperation survival. The Cox model identified the older age (p = 0.022), LVEF ≤ 35 % (p = 0.009), reoperation (p = 0.018), combined surgery (p = 0.00075) and annulus enlargement (p = 0.033) as strong predictors for poor actuarial free-reoperation survival. CONCLUSIONS Both the SJMR-19 and CE-19 offers excellent postoperative clinical and hemodynamic outcome in patients with small aortic annulus. The LV hypertrophy and transvalvular gradients are reduced significantly indenpendently of the employed SJMR-19 or CE-19 prosthesis. Our data support recent suggestions that small valve size does not influence intermediate free-reoperation survival. The CE-19 is an excellent alternative to SJMR-19 in old patients.
Collapse
Affiliation(s)
- Edvin Prifti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Massimo Bonacchi
- Department of Cardiovascular Sciences, Policlinico Careggy, University of Florence, Florence, Italy
| | - Fadil Ademaj
- University Hospital Center of Pristina, Pristina, Kosovo.
| | - Gabriele Giunti
- Department of Cardiovascular Sciences, Policlinico Careggy, University of Florence, Florence, Italy
| | | | - Arben Baboci
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | | | - Altin Veshti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Aurel Demiraj
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Vittorio Vanini
- Division of Cardac Surgery, Humanitas Gavazzeni Clinic, Bergamo, Italy
| |
Collapse
|
7
|
Prifti E, Bonacchi M, Baboci A, Giunti G, Esposito G, Kajo E, Nuellari E, Vanini V. Does the St. Jude Regent 17-mm Offer Better Outcomes Than the Hemodynamic Plus 17-mm Aortic Valve Mechanical Prothesis? J Card Surg 2015; 30:787-95. [PMID: 26447362 DOI: 10.1111/jocs.12637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study is to report the early and mid-term clinical and hemodynamic results of a prospective trial investigating the clinical performance of the St. Jude Medical Regent 17 mm (SJMR-17) versus St. Jude Medical Hemodynamic Plus 17 mm (SJMHP-17). MATERIALS AND METHODS Between January 2000 and August 2013, 20 patients (Group I) with aortic valve (AV) stenosis underwent first time AV replacement with a SJMR-17 and nine patients (Group II) underwent AV replacement with a SJMHP-17. The mean follow-up was 58 ± 31 months. RESULTS There was one death in Group I. The end-diastolic IVS thickness and end-systolic posterior left ventricle (LV) wall thickness was reduced significantly in boths groups (p = 0.001 and p = 0.006 in Group I and p = 0.007 and p = 0.011 in Group II). The peak and mean transprosthesis gradients (P-TPG and M-TPG) were 29 ± 6.8 mmHg and 17.5 ± 4.5 mmHg in Group I, significantly lower than in Group II (55.2 ± 19.7 mmHg and 28.8 ± 7.7 mmHg). The postoperative left ventricular mass (LVM) and indexed left ventricular mass (LVMi) were reduced significantly in both groups versus the preoperative values. The postoperative LVMi was 114.5 ± 10.6 g/m(2) in Group I versus 127 ± 8 g/m(2) in Group II (p = 0.01). With dobutamine, heart rate, left ventricular ejection fraction, cardiac output, transprosthesis peak, and mean gradients increased significantly in both groups, however, the P-TPG and M-TPG were significantly higher in Group II (p = 0.026 and p = 0.022) despite a non-significant increase of the indexed effective orifice area. CONCLUSIONS The SJMR-17 can be employed with satisfactory postoperative clinical and hemodynamic outcomes in patients with small aortic annulus, especially in elderly patients offering better outcome than SJMHP-17.
Collapse
Affiliation(s)
- Edvin Prifti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Albania
| | - Massimo Bonacchi
- Division of Cardiac Surgery, Policlinicco Careggi, Florence, Italy
| | - Arben Baboci
- Division of Cardiac Surgery, University Hospital Center of Tirana, Albania
| | - Gabriele Giunti
- Division of Cardiac Surgery, Policlinicco Careggi, Florence, Italy
| | | | - Efrosina Kajo
- Division of Cardiac Surgery, University Hospital Center of Tirana, Albania
| | - Edmond Nuellari
- Division of Cardiac Surgery, University Hospital Center of Tirana, Albania
| | - Vittorio Vanini
- Division of Cardiac Surgery, Humanitas Gavazzeni Clinic, Bergamo, Italy
| |
Collapse
|
8
|
Prakash S, Agarwal S, Dutta N, Satsangi DK. A comparative study of surgical treatment of small aortic root with or without aortic root enlargement using a single prosthesis type. J Cardiovasc Med (Hagerstown) 2010; 11:836-42. [DOI: 10.2459/jcm.0b013e32833e5687] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
9
|
Sezai A, Kasamaki Y, Abe K, Hata M, Sekino H, Shimura K, Minami K. Assessment of the St. Jude Medical Regent Prosthetic Valve by Continuous-Wave Doppler and Dobutamine Stress Echocardiography. Ann Thorac Surg 2010; 89:87-92. [DOI: 10.1016/j.athoracsur.2009.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/31/2009] [Accepted: 09/01/2009] [Indexed: 11/28/2022]
|
10
|
Narayan P, Reeves BC, Rizvi SIA, Shokrollahi K, Ismail H, Angelini GD, Nightingale A, Caputo M. Hemodynamic evaluation and midterm outcome of aortic valve replacement with size 19 Perimount prosthetic valve. Ann Thorac Surg 2008; 86:1799-803. [PMID: 19021980 DOI: 10.1016/j.athoracsur.2008.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 08/08/2008] [Accepted: 08/11/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND We sought to investigate the effect of patient prosthesis mismatch on hemodynamic profile using dobutamine stress echocardiography, and to evaluate midterm survival of patients undergoing aortic valve replacement with 19-mm Perimount (Baxter Healthcare, Santa Ana, California) aortic prosthetic valves. METHODS Between December 1, 1999, and August 17, 2005, 147 patients (mean age, 76.8 +/- 5.51 years) had aortic valves replaced with 19-mm Perimount prostheses. Dobutamine stress echocardiography was performed in a subgroup of 24 patients (mean age, 76.6 +/- 5.60 years). Univariable predictors of peak transprosthetic gradient (PTG) under maximum stress, adjusted for resting PTG, were investigated by regression. Survival in the whole cohort was described, and univariable predictors of survival were investigated by Cox regression. RESULTS In the stress echocardiography subgroup, cardiac output (p < 0.0001), PTG (p < 0.0001), and effective orifice area index increased significantly (p = 0.002) under stress. Peak transprosthetic gradient under stress was strongly associated with PTG at rest (p < 0.0001). After controlling for PTG at rest, no other variables were associated with PTG under stress. In the whole cohort, mean duration of follow-up was 2.21 years; 23 patients died. Neither body surface area nor effective orifice area index was significantly associated with survival. CONCLUSIONS The 19-mm Perimount aortic prosthesis has acceptable hemodynamic performance. Transvalvular gradients were within a clinically acceptable range, both at rest and under stress. These findings suggest that patient-prosthesis mismatch is unlikely to cause a clinically important problem when the prosthesis is used, which is consistent with survival experience in the whole cohort.
Collapse
Affiliation(s)
- Pradeep Narayan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Kato Y, Tsutsumi Y, Kawai T, Goto T, Takahashi Y, Ohashi H. Aortic valve replacement for aortic stenosis in the elderly: influence of prosthesis-patient mismatch on late survival and left ventricular mass regression. Gen Thorac Cardiovasc Surg 2008; 56:397-403. [PMID: 18696205 DOI: 10.1007/s11748-008-0261-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 04/04/2008] [Indexed: 01/02/2023]
Abstract
PURPOSE Controversy still exists about the influence of prosthesis-patient mismatch on outcomes after aortic valve replacement in the elderly. Our aim was to evaluate the effect of prosthesis-patient mismatch on survival and the extent of left ventricular (LV) mass regression after aortic valve replacement for aortic stenosis in Japanese patients aged >or=65 years. MATERIALS AND METHODS A total of 84 patients who underwent isolated aortic valve replacement for aortic stenosis between 1986 and 2006 were retrospectively analyzed. Patients were divided into two groups based on the definition of prosthesis-patient mismatch (indexed effective orifice area <or=0.85 cm(2)/m(2)), and long-term results were compared. The mean follow-up time was 4.5 +/- 4.5 years. In 49 patients, follow-up echocardiography was performed at least 6 months after surgery, and the extent of LV mass regression was analyzed according to the presence of a prosthesis-patient mismatch. RESULTS Eight years after surgery, there was no significant difference between patients with and without mismatch in terms of actuarial freedom from cardiac-related death (P = 0.159) or death from any valve-related events (P = 0.107). The postoperative transvalvular pressure gradients were not significantly different between the two groups, and significant absolute and relative LV mass regression were observed in both groups. CONCLUSION Although a moderate prosthesis-patient mismatch appeared to be tolerable, the criteria of prosthesis-patient mismatch may have to be reassessed for elderly Japanese patients.
Collapse
Affiliation(s)
- Yasuyuki Kato
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinbo, Fukui 910-0833, Japan.
| | | | | | | | | | | |
Collapse
|
12
|
|
13
|
Ardal H, Toker ME, Rabuş MB, Uyar I, Antal A, Sişmanoğlu M, Mansuroğlu D, Kirali K, Yakut C. Does Aortic Root Enlargement Impair the Outcome of Patients With Small Aortic Root? J Card Surg 2006; 21:449-53. [PMID: 16948753 DOI: 10.1111/j.1540-8191.2006.00274.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior root enlargement procedures provide the implantation of suitable-sized prosthetic valves in patients with a small aortic root to prevent a high postoperative transvalvular gradient. The aim of this study was to evaluate long-term results of the posterior root enlargement. METHODS Between 1985 and 2002, 124 patients underwent aortic valve replacement with a posterior root enlargement. The main indication was a small aortic valve orifice area to patient body surface area (indexed valve area < 0.85 cm2/m2). Fifty-four (44%) patients were male, and 70 (56%) were female with a mean age 39.1 +/- 14.3 years. Indications for operation were severe calcified aortic valve stenosis (37.1%), severe aortic insufficiency (25.8%), or combination (37.1%). Seventy-five (60%) patients received double-valve replacement. A pericardial patch was used in 100 patients (80.6%) and a Dacron patch was used in 24 patients. RESULTS Operative mortality was 6.4% (8 patients). The causes of hospital mortality were low cardiac output syndrome (LCOS) (in 6 patients), cerebrovascular events (in 1 patient) and multiple organ failure (in 1 patient). Multivariate analysis demonstrated concomitant coronary revascularization to be a significant (p = 0.03) predictor for early mortality. There were six (5.4%) late deaths. Cox proportional hazards regression analysis demonstrated LCOS (p = 0.013) and infective endocarditis (p = 0.003) to be significant predictors for late mortality. Atrioventricular block required a permanent pacemaker was observed in 4 patients (3.2%). CONCLUSIONS Posterior aortic root enlargement techniques can be easily applied without additional risks. Long-term survival and freedoms from valve-related complications are satisfactory.
Collapse
Affiliation(s)
- Hasan Ardal
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Kadikoy, Istanbul, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Flameng W, Meuris B, Herijgers P, Herregods MC. Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valve. Ann Thorac Surg 2006; 82:530-6. [PMID: 16863756 DOI: 10.1016/j.athoracsur.2006.03.089] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2006] [Revised: 03/25/2006] [Accepted: 03/28/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have shown that prosthesis-patient mismatch (PPM) results in higher early and late mortality after bioprosthetic aortic valve replacement. Careful selection of stented bioprostheses was recommended to avoid inadequate effective orifice area. We studied the incidence of PPM and its potential effects on clinical outcome in patients undergoing aortic valve replacement using the Carpentier-Edwards Perimount bioprosthesis. METHODS Independent predictors of early and late mortality and hospital readmission for cardiac reasons were defined in 506 patients (mean age, 73 years; range, 57 to 87 years) by multivariate analysis. Mean follow-up was 6.1 +/- 4.8 years; maximum follow-up was 18.6 years. RESULTS The incidence of severe PPM (effective orifice area index < 0.65 cm2/m2) was 0.2% and of moderate PPM (effective orifice area index > 0.65 and < 0.85) was 20%. Multivariate analysis revealed that moderate PPM was not an independent predictor of early mortality, late mortality, or hospital readmission for cardiac reasons. Reduction of septal hypertrophy was similar in patients with and without moderate PPM. CONCLUSIONS The incidence of severe PPM is virtually nonexistent after aortic valve replacement using the Carpentier-Edwards Perimount valve. Moderate PPM is found in 20% of cases and is clinically irrelevant in this population.
Collapse
Affiliation(s)
- Willem Flameng
- Department of Cardiac Surgery, University Clinic Gasthuisberg, Leuven, Belgium.
| | | | | | | |
Collapse
|
15
|
Shimomura T, Eda T, Suzuki S, Miyahara K, Matsuura A, Yoshida K. Aortic valve replacement with a 16-mm CarboMedics valve in adult patients. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2006; 54:239-41. [PMID: 16813104 DOI: 10.1007/pl00022243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Management of the small aortic root is a significant problem for the surgeon with regard to operative technique and selection of the prosthesis. We report on four adults with a small aortic root who underwent aortic valve replacement with a 16-mm CarboMedics bileaflet valve. All patients now lead normal lives. Postoperative Doppler measurements demonstrated an acceptable transprosthetic gradient.
Collapse
Affiliation(s)
- Takeru Shimomura
- Division of Cardiovascular Surgery, Aichi Prefectural Owari Hospital, Ichinomiya, Japan
| | | | | | | | | | | |
Collapse
|
16
|
Pai RK, Lad V, Agarwal N, Khandeparkar J, Patwardhan A. Implications of valve prosthesis-patient mismatch in patients undergoing aortic valve replacement; who tolerates and who does not? Indian J Thorac Cardiovasc Surg 2005. [DOI: 10.1007/s12055-005-0002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
17
|
Amarelli C, Della Corte A, Romano G, Iasevoli G, Dialetto G, De Santo LS, De Feo M, Torella M, Scardone M, Cotrufo M. Left ventricular mass regression after aortic valve replacement with 17-mm St Jude Medical mechanical prostheses in isolated aortic stenosis. J Thorac Cardiovasc Surg 2005; 129:512-7. [PMID: 15746732 DOI: 10.1016/j.jtcvs.2004.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The present study investigated the outcomes of aortic valve replacement with 17-mm mechanical prostheses in patients with isolated aortic stenosis. METHODS Between January 1997 and January 2003, 35 patients (mean age, 63.4 +/- 17 years; median age, 70 years; age range, 16-84 years) underwent isolated aortic valve replacement with a 17-mm St Jude Medical Hemodynamic Plus (16 [45.7%] patients) or a St Jude Medical Regent prosthesis (19 [54.3%] patients). The paired Student t test or the paired Wilcoxon rank sum test were used to compare preoperative with follow-up echocardiographic measurements. RESULTS Thirty-two (91.4%) patients were female, mean height was 154.4 +/- 8.3 cm, mean weight was 62.2 +/- 9.2 kg, and mean body surface area was 1.59 +/- 0.13 m 2 . The preoperative average New York Heart Association class was 2.8 +/- 0.8. The mean preoperative left ventricular mass index was 135.2 +/- 31 g/m 2 . Preoperative echocardiography showed an average gradient of 65.7 +/- 19.2 mm Hg (mean) and 103.6 +/- 30.7 mm Hg (peak) and a mean indexed effective orifice area of 0.40 +/- 0.1 cm 2 /m 2 . Echocardiographic follow-up time averaged 28.2 +/- 22.7 months (range, 13-72 months). Follow-up was 100% complete (1131.7 patient-months). Hospital mortality was 8.6% (3 patients). Actuarial 5-year survival was 94.7%. The mean postoperative New York Heart Association class was 1.13 +/- 0.34 ( P < .001), with 27 (87.1%) patients in class I and 4 patients in class II. A significant regression of the indexed left ventricular mass was found (postoperative mean value, 107.8 +/- 22.8 g/m 2 ; P < .0001), despite a mean indexed effective orifice area of 0.67 +/- 0.14 cm 2 /m 2 (median, 0.66 cm 2 /m 2 ). CONCLUSIONS Selected patients with aortic stenosis can experience satisfactory clinical improvement and significant indexed left ventricular mass regression after aortic valve replacement with modern small-diameter bileaflet prostheses.
Collapse
Affiliation(s)
- Cristiano Amarelli
- Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, V Monaldi Hospital, Naples, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Blackstone EH, Cosgrove DM, Jamieson WRE, Birkmeyer NJ, Lemmer JH, Miller DC, Butchart EG, Rizzoli G, Yacoub M, Chai A. Prosthesis size and long-term survival after aortic valve replacement. J Thorac Cardiovasc Surg 2003; 126:783-96. [PMID: 14502155 DOI: 10.1016/s0022-5223(03)00591-9] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was undertaken to quantify the relationship between prosthesis size adjusted for patient size (prosthesis-patient size) and long-term survival after aortic valve replacement. METHODS Data from nine representative sources on 13,258 aortic valve replacements provided 69,780 patient-years of follow-up (mean 5.3 +/- 4.7 years), with reliable survival estimates to 15 years. Prostheses included 5757 stented porcine xenografts, 3198 stented bovine pericardial xenografts, 3583 mechanical valves, and 720 allografts. Manufacturers' labeled prosthesis size was 19 mm or smaller in 1109 patients. Expressions of prosthesis-patient size assessed were indexed internal prosthesis orifice area (in centimeters squared per square meter of body surface area) and standardized internal prosthesis orifice size (Z, the number of SDs from mean normal native aortic valve size). Multivariable hazard domain analysis with balancing score and risk factor adjustment quantified the association of prosthesis-patient size with survival. RESULTS Prosthesis-patient size down to at least 1.1 cm(2)/m(2) or -3 Z did not adversely affect intermediate- or long-term survival (P >.2). However, 30-day mortality increased 1% to 2% when indexed orifice area fell below 1.2 cm(2)/m(2) (P =.002) or standardized orifice size fell below -2.5 Z (P =.0003). The increased early risk affected fewer than 1% of patients receiving bioprostheses but about 25% of those receiving mechanical devices. CONCLUSIONS Aortic prosthesis-patient size down to 1.1 cm(2)/m(2) or -3 Z did not reduce intermediate- or long-term survival after aortic valve replacement. However, patient-prosthesis size under 1.2 cm(2)/m(2) or -2.5 Z was associated with a 1% to 2% increase in 30-day mortality. Prosthesis-patient sizes this small or smaller were rarely implanted in patients receiving bioprostheses.
Collapse
Affiliation(s)
- Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Florath I, Rosendahl UP, Mortasawi A, Bauer SF, Dalladaku F, Ennker IC, Ennker JC. Current determinants of operative mortality in 1400 patients requiring aortic valve replacement. Ann Thorac Surg 2003; 76:75-83. [PMID: 12842517 DOI: 10.1016/s0003-4975(03)00341-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Determinants of operative mortality after aortic valve replacement vary with a changing patient population due to advances in operative management and increasing life expectancy. In order to predict current groups of high risk patients, a statistically valid large study population base recruited over a short period of time is required. METHODS Between January 1996 and June 2001, 1408 aortic valves were replaced in 1400 patients (572 of them with simultaneous coronary artery bypass grafting). The data were analyzed by multivariate logistic regression to evaluate the operative risk. Mean age of the study population was 68 +/- 11 years (range 19 to 90 years old, 44% female). RESULTS Overall operative mortality (within 30 days) was 3.8%. Independent predictive factors for operative mortality were previous bypass surgery, emergency operation, simultaneous mitral valve replacement, renal dysfunction, more than 80 years old, simultaneous bypass surgery in female patients with a body mass index greater than 29 kg/m(2), and height smaller than 1.57 m for patients more than 71 years old. Simultaneous coronary artery bypass grafting in general (p = 0.6), previous aortic valve replacement (p = 0.59), and implantation of stented bioprostheses (p = 0.39) or stentless bioprostheses (p = 0.7) were not identified as independent risk factors. CONCLUSIONS Certain groups of patients with a high operative risk were identified: patients more than 80 years old, women with a body mass index greater 29 kg/m(2) undergoing simultaneous coronary artery bypass surgery, and "small" patients more than 71 years old.
Collapse
Affiliation(s)
- Ines Florath
- Department of Cardiothoracic Surgery, Heart Institute Lahr/Baden, Lahr, Germany
| | | | | | | | | | | | | |
Collapse
|
20
|
Silberman S, Shaheen J, Merin O, Fink D, Shapira N, Liviatan-Strauss N, Bitran D. Exercise hemodynamics of aortic prostheses: comparison between stentless bioprostheses and mechanical valves. Ann Thorac Surg 2001; 72:1217-21. [PMID: 11603439 DOI: 10.1016/s0003-4975(01)03064-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Nonstented bioprostheses have been associated with lower resting gradients than stented bioprostheses or mechanical valves. We compared the hemodynamic performance of nonstented bioprostheses and mechanical valves with normal native aortic valves at rest and exercise. METHODS Dobutamine echocardiography was used to assess gradients and effective orifice area index at rest and exercise in patients with the Toronto stentless porcine valve (TSPV; n = 13; mean implant size 25.7 mm), Medtronic Freestyle (FR; n = 11; mean implant size 23.9 mm), Sorin Bicarbon (SOR; n = 11; mean implant size 24.5 mm), St. Jude Medical (SJM; n = 10; mean implant size 21.3 mm), and normal native aortic valves (NOR; n = 10). RESULTS All groups demonstrated a major rise in cardiac output at maximal dobutamine infusion. At rest and exercise, respectively, mean gradients were 5.48 +/- 1.1 mm Hg and 5.83 +/- 0.9 mm Hg for TSPV, 5.68 +/- 1.2 mm Hg and 7.50 +/- 1.7 mm Hg for FR, 10.29 +/- 1.4 mm Hg and 20.78 +/- 2.7 mm Hg for SJM, 5.26 +/- 0.8 mm Hg and 11.1 +/- 1.8 mm Hg for SOR, and 1.54 +/- 0.4 mm Hg and 2.18 +/- 0.7 mm Hg for NOR. In comparison with normal valves, both stentless groups showed no change in mean gradient at exercise, whereas both mechanical groups showed an increase in gradient at exercise (p < 0.04). CONCLUSIONS Stentless valves behave similarly to normal aortic valves in that there is almost no increase in gradient at exercise. Both mechanical valve groups showed increased gradients at exercise, suggesting that these valves obstruct blood flow. Our data add further evidence that stentless valves are hemodynamically superior to mechanical valves in the aortic position.
Collapse
Affiliation(s)
- S Silberman
- Department of Cardiac Surgery, Shaare Zedek Medical Center, Jerusalem, Israel.
| | | | | | | | | | | | | |
Collapse
|
21
|
Knez I, Rienmüller R, Maier R, Rehak P, Schröttner B, Mächler H, Anelli-Monti M, Rigler B. Left ventricular architecture after valve replacement due to critical aortic stenosis: an approach to dis-/qualify the myth of valve prosthesis-patient mismatch? Eur J Cardiothorac Surg 2001; 19:797-805. [PMID: 11404133 DOI: 10.1016/s1010-7940(01)00683-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES Left ventricular hypertrophy in patients with critical aortic stenosis (AS) is an adaptive process that compensates for high intracavitary pressure and reduces systolic wall stress followed by an increase in myocardial masses. In the present prospective clinical trial, we investigated long-term compensatory changes in left ventricular geometry and function after aortic valve replacement using mechanical bileaflet prostheses with the main emphasis on the small-sized aortic annulus and valve prosthesis-patient mismatch. METHODS A total of 58 patients with critical AS were assigned to the following groups according to the predictive value of prosthetic valve area index (VAI): group EXMIS: 29 patients (VAI < or =0.99), expected mismatch; group NOMIS: 29 patients (VAI < or =0.99), no mismatch. At controls T(0) (before operation/operation (OP), T(1) and T(2) (4 and 20 months after OP) the left ventricular geometry was recorded by means of Imatron electron beam tomography and the transprosthetic velocities were measured by echocardiography. RESULTS Statistical analysis showed a consistent reduction in the absolute (P=0.04) and indexed (P=0.04) left ventricular myocardial mass for both cohorts; furthermore, there was a significant difference between EXMIS and NOMIS patients concerning the factors, time and mass reduction (P=0.005), because of distinct baselines. A logistic regression report revealed preoperative cardiac output, absolute left ventricular myocardial mass, perfusion, body surface area and the native valve orifice area as predicting coefficients and factors for a minimum mass reduction of 25%. We explain a mathematical formula that turned out to be the most sensitive for correctly classified factors. CONCLUSIONS The left ventricular geometry and transprosthetic velocities resulted in the same postoperative recovery for both EXMIS and NOMIS patients. The presented data showed that valve prosthesis-patient mismatch had no influence in several stepwise logistic regression models. We conclude that modern mechanical bileaflet prostheses allow both acceptable hemodynamics and recovery of left ventricular hypertrophy, even in small aortic annuli.
Collapse
Affiliation(s)
- I Knez
- Division of Cardiac Surgery, Karl Franzens University and Medical School of Graz, Graz, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Carrier M, Pellerin M, Perrault LP, Hébert Y, Pagé P, Cartier R, Dyrda I, Pelletier LC. Experience with the 19-mm Carpentier-Edwards pericardial bioprosthesis in the elderly. Ann Thorac Surg 2001; 71:S249-52. [PMID: 11388197 DOI: 10.1016/s0003-4975(01)02508-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Valve replacement in small aortic root remains a surgical challenge. The objective of this study was to compare results of the 19-mm bioprosthesis with those of larger prostheses in the elderly. METHODS The 443 patients, 70 years of age and older, who underwent aortic valve replacement with Carpentier-Edwards pericardial bioprostheses were reviewed. RESULTS There were 93 patients with a mean age of 76+/-4 years with implantation of 19-mm prostheses and 350 patients with a mean age of 75+/-4 years with larger bioprostheses. Associated aortoplasty was performed in 10 patients (11%) with 19-mm bioprostheses and in 8 patients (2%) with larger bioprostheses (p = 0.001). There were 11 deaths (12%) within 30 days of surgery in patients with 19-mm prostheses and 22 deaths (6%) among those with larger prostheses (p = 0.1). The 7-year survival rate averaged 61%+/-7% in patients with 19-mm prostheses and 67%+/-4% in those with larger prostheses (p = 0.8). The 7-year freedom rates from all valve-related events averaged 96%+/-2% and 93%+/-2%, respectively (p = 0.6). CONCLUSIONS Aortic valve replacement with the 19-mm Carpentier-Edwards pericardial bioprosthesis offers excellent midterm results in the elderly.
Collapse
Affiliation(s)
- M Carrier
- Department of Surgery and Medicine, Montreal Heart Institute, and the University of Montreal, Quebec, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Thomson DJ, Jamieson WR, Dumesnil JG, Burgess JJ, Peniston CM, Métras J, Sullivan JA, Parrott JC, Maitland A, Cybulsky IJ. Medtronic Mosaic porcine bioprosthesis: midterm investigational trial results. Ann Thorac Surg 2001; 71:S269-72. [PMID: 11388202 DOI: 10.1016/s0003-4975(01)02551-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The midterm clinical and hemodynamic performance of the Medtronic Mosaic porcine bioprosthesis was evaluated in a regulatory trial. METHODS In nine Canadian centers, 802 bioprostheses (560 aortic and 242 mitral) were implanted between September 1994 and April 1999 in patients with a mean age of 70 years. RESULTS Survival for aortic valve replacement at 4 years was 84.4%+/-3.1%. Freedom from valve-related or unexplained death was 95.6%+/-1.9%; structural valve deterioration, 100.0%; reoperation, 96.2%+/-1.7%; major thromboembolism, 96.1%+/-1.8%; and major antithrombotic-related hemorrhage, 96.4%+/-1.7%. Echocardiographic derived mean systolic gradient was 13.4 mm Hg at 4 years with an indexed effective orifice area of 0.7 to 0.8 cm2/m2. A significant decrease in left ventricular mass was shown over time in all valve sizes. Survival for mitral valve replacement at 4 years was 79.2%+/-6.8%. Freedom from valve-related or unexplained death was 96.5%+/-3.4%; structural valve deterioration, 100%; reoperation, 97.0%+/-3.2%; major thromboembolism, 95.7%+/-3.8%; and major antithrombotic-related hemorrhage, 95.0%+/-4.2%. Echocardiographically measured averaged mean diastolic gradient was 4.5 mm Hg. CONCLUSIONS The Medtronic Mosaic bioprosthesis is safe and effective in both the aortic and mitral positions. The valve has low gradients in both positions and excellent left ventricular mass regression in the patients with aortic valve replacement.
Collapse
Affiliation(s)
- D J Thomson
- Department of Cardiovascular Surgery, University of Saskatchewan, Saskatoon, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
|