Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement

Abstract Aims Indexed effective orifice area (EOAi) charts are used to determine the likelihood of prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR). The aim of this study is to validate whether these EOAi charts, based on echocardiographic normal reference values, can accurately predict PPM. Methods and results In the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial, 986 patients with aortic valve stenosis/regurgitation underwent AVR with an Avalus valve. Patients were randomly split (50:50) into training and test sets. The mean measured EOAs for each valve size from the training set were used to create an Avalus EOAi chart. This chart was subsequently used to predict PPM in the test set and measures of diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) were assessed. PPM was defined by an EOAi ≤0.85 cm2/m2, and severe PPM was defined as EOAi ≤0.65 cm2/m2. The reference values obtained from the training set ranged from 1.27 cm2 for size 19 mm up to 1.81 cm2 for size 27 mm. The test set had an incidence of 66% of PPM and 24% of severe PPM. The EOAi chart inaccurately predicted PPM in 30% of patients and severe PPM in 22% of patients. For the prediction of PPM, the sensitivity was 87% and the specificity 37%. For the prediction of severe PPM, the sensitivity was 13% and the specificity 98%. Conclusion The use of echocardiographic normal reference values for EOAi charts to predict PPM is unreliable due to the large proportion of misclassifications.

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Measuring effective orifice area of bileaflet mechanical valves in patients after aortic valve replacement using phase-contrast cine MR imaging

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-13-s1-p325 ◽

2011 ◽

Vol 13 (S1) ◽

Author(s):

Haruhiko Machida ◽

Masami Hirata ◽

Shinya Kojima ◽

Kazufumi Suzuki ◽

Eiko Ueno ◽

...

Keyword(s):

Aortic Valve ◽

Mr Imaging ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Phase Contrast ◽

Effective Orifice Area ◽

Orifice Area ◽

Cine Mr ◽

Mechanical Valves ◽

Bileaflet Mechanical Valves

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Aortic valve replacement in elderly with small aortic root and low body surface area; the Perceval S valve and its impact in effective orifice area

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-016-0438-7 ◽

2016 ◽

Vol 11 (1) ◽

Cited By ~ 18

Author(s):

Panagiotis Dedeilias ◽

Nikolaos G. Baikoussis ◽

Efstathia Prappa ◽

Dimitrios Asvestas ◽

Michalis Argiriou ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Surface Area ◽

Body Surface Area ◽

Valve Replacement ◽

Body Surface ◽

Aortic Root ◽

Effective Orifice Area ◽

Orifice Area ◽

Small Aortic Root

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Accuracy of Industry Generated Effective Orifice Area Calculators for Aortic Valve Replacement

Heart Lung and Circulation ◽

10.1016/j.hlc.2012.05.670 ◽

2012 ◽

Vol 21 ◽

pp. S274

Author(s):

J. Chan ◽

P. Naidu ◽

A. Cheng ◽

J. Kumar ◽

A. Appelbe ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Effective Orifice Area ◽

Orifice Area

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Immediate results of aortic valve reconstruction by using autologous pericardium (Ozaki procedure)

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2016-3-26-30 ◽

2016 ◽

Vol 20 (3) ◽

pp. 26 ◽

Cited By ~ 4

Author(s):

E V Rosseykin ◽

V V Bazylev ◽

P A Batrakov ◽

V A Karnakhin ◽

A A Rastorguev

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Postoperative Period ◽

Conflict Of Interest ◽

Effective Orifice Area ◽

Orifice Area ◽

Autologous Pericardium ◽

Valve Reconstruction ◽

Biological Prostheses

Aim. The study was designed to compare the immediate echocardiographic characteristics of aortic valve reconstruction by using autologous pericardium and the method proposed in 2007 by Shigeyuki Ozaki, as well as aortic valve replacement by means of frame-mounted biological prostheses Medtronic HANCOCK®II T505 CINCH® II and the Carpentier-Edwards PERIMOUNT. Methods. Over a period from January 2014 to February 2016, 76 patients underwent aortic valve replacement by means of frame-mounted biological prostheses Medtronic HANCOCK®II T505 CINCH® II (n=41) and Carpentier-Edwards PERIMOUNT (n=35) at our hospital. 20 patients underwent the Ozaki procedure. These three groups of patients were assigned to the study. Demographic and preoperative indicators of patients from all three groups were homogeneous (р>0.05). The evaluation of the aortic valves replaced was carried out by echocardiography. Results. Echocardiography was performed before the procedure and in the early postoperative period. Statistical analysis using ANOVA showed significantly lower values of the aortic valve pressure gradient (p<0.001) and larger effective orifice area and indexed effective orifice area of the valve (p<0.001) in the group of the Ozaki procedure. Conclusion. According to echocardiography data, in the immediate postoperative period the Ozaki procedure is associated with lower mean and peak gradients of pressure on the aortic valve and larger effective orifice area and indexed effective orifice area of the valve, as compared with the frame-mounted biological aortic prostheses Medtronic HANCOCK®II T505 CINCH® II and the Carpentier-Edwards PERIMOUNT. Received 27 May 2016. Accepted 24 June 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest.

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Impact of valve size, effective and indexed effective orifice area after aortic valve replacement.

10.22541/au.159714186.69828879 ◽

2020 ◽

Author(s):

Suvitesh Luthra ◽

Pietro Malvindi ◽

Carlo Olevano ◽

Anna Zingale ◽

Hamdi Salem ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Effective Orifice Area ◽

Orifice Area ◽

Valve Size

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P2270Clinical characteristics and outcomes after TAVI in patients reclassified to moderate aortic stenosis by integration of multimodality imaging and pressure recovery

European Heart Journal ◽

10.1093/eurheartj/ehz748.0747 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E W Holy ◽

D L Nguyen-Kim ◽

L Hoffelner ◽

D L Stocker ◽

T Stadler ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Effective Orifice Area ◽

Orifice Area ◽

Junction Area ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Accurate assessment of aortic stenosis (AS) severity is critical for the correct management of patients. This has become particularly important because the introduction of transcatheter aortic valve implantation (TAVI) has markedly increased the number of patients eligible for aortic valve replacement Aims To assess whether reclassification of aortic stenosis (AS) grading by integration of fusion imaging using data from transthoracic echocardiography (TTE) and multidetector computed tomography (MDCT) under consideration of the energy loss index (ELI) predicts outcome in patients undergoing transcatheter aortic valve implantation (TAVI). Methods 197 consecutive patients with symptomatic severe AS undergoing TAVI at our University Heart Center were included in this study. AS severity was determined according to current guidelines. Results Left ventricular outflow tract (LVOT) area derived from TTE was smaller than the planimetric area in MDCT due the ovoid shape of the LVOT (3.4±0.12 cm2 vs. 4.5±0.23 cm2; p<0.01). The sinotubular junction (ST-junction) diameter measured in TTE was similar to maximal, minimal, and mean diameters determined by MDCT. The sphericity index confirmed an almost circular anatomy of ST-junction, and its area derived from TTE was similar to the planimetric area in MDCT. Fusion aortic valve area index (fusion AVAi) assessed by inserting MDCT derived planimetric LVOT area in the continuity equation was significantly higher in all patients compared to conventional AVAi. 62 patients were reclassified from severe to moderate AS because fusion AVAi was >0.6 cm2/m2. ELI was calculated for conventional AVAi and fusion AVAi each with ST-junction area determined by both TTE and MDCT. Calculating ELI with fusion AVAi resulted in significantly larger effective orifice area, with values >0.6 cm2/m2 in 83 patients (ST-junction area from echo) and 85 patients (ST-junction area from MDCT). Similarly, calculating ELI with conventional AVAi resulted in significantly larger effective orifice area as compared to AVAi alone. Reclassified patients had lower mean transvalvular pressure gradients, lower myocardial mass, less symptoms according to NYHA classification, and lower proBNP levels at baseline. While both groups exhibited improvement of functional status at 1 year of follow-up, the survival rate at 3 years after TAVI was higher in patients reclassified to moderate AS (81% versus 66%; p=0.02). Conclusion Integration of TTE and MDCT derived values for calculation of ELI reclassifies the severity of AS in 43% of patients initially diagnosed with severe AS.Although reclassified patients display less advanced valve disease at baseline, TAVI results in functional improvement in all patients. Furthermore, patients reclassified to moderate AS exhibit higher survival rates at 3 years after aortic valve replacement.

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