Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are standard procedures for dealing with severe aortic stenosis patients. Researchers have not carried out a systematic review of the volume-outcome relationship in TAVR and SAVR. Our study is intended to address this problem. We systemically searched databases through MEDLINE, EMBASE, PUBMED, and the Cochrane Library up to September 2019. Two reviewers independently screened for the studies and evaluated bias. We used short-term mortality (in-hospital or 30-day mortality) as an outcome. A meta-analysis of TAVR with 115,596 patients ranging from 2005 to 2016 showed a result significantly in favor of high-volume hospitals (OR 0.43 (CI 0.36-0.51)). The subgroup of population period, region, data type, and cut-off value did not show any difference. A meta-analysis of SAVR comprising 418,384 patients ranging from 1994 to 2011 revealed that the OR of short-term mortality for a high-volume hospital compared with that of a low-volume hospital was 0.73 (CI 0.71, 0.74). No difference was observed in subgroups based on population period and cut-off. In conclusion, we found that short-term mortality was lower in high-volume hospitals for both TAVR and SAVR.

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Low Short Term Mortality in Isolated Aortic Valve Replacement; Implications for Decision Making for Patient Selection for Surgery and Transcatheter Techniques

Heart Lung and Circulation ◽

10.1016/j.hlc.2012.05.684 ◽

2012 ◽

Vol 21 ◽

pp. S280

Author(s):

D. Mullany ◽

B. Thomson ◽

L. Drake ◽

P. Tesar ◽

D. Walters

Keyword(s):

Decision Making ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Patient Selection ◽

Short Term ◽

Short Term Mortality ◽

Selection For

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Prosthesis-Patient Mismatch Causes a Significantly Increased Risk of Operative Mortality in Aortic Valve Replacement

The Heart Surgery Forum ◽

10.1532/hsf98.2013304 ◽

2014 ◽

Vol 17 (3) ◽

pp. 127 ◽

Cited By ~ 1

Author(s):

Muhammad Shahzeb Khan ◽

Faizan Imran Bawany ◽

Asadullah Khan ◽

Mehwish Hussain

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Operative Mortality ◽

Univariate Analysis ◽

Female Gender ◽

Valve Prosthesis ◽

Predictors Of Mortality ◽

Increased Risk ◽

Urgent Operation

Background: Small aortic prosthesis can lead to prosthesis-patient mismatch (PPM). Implanting such small prosthesis remains a controversial issue. This study was done to investigate whether or not PPM causes an increased operative mortality in aortic valve replacement (AVR).Methods: Two-hundred-two consecutive patients undergoing primary AVR in a tertiary hospital were included. The sample was grouped according to the aortic valve prosthesis size: ?21 mm (small) and >21 mm (standard). The effect of variables on outcomes was determined by univariate and multivariable regression analyses.Results: PPM was found significantly more among patients with AVR ? 21mm (P < 0.0001). Moreover, the likelihood of mortality also was significantly higher in these patients (P < 0.0001). Univariate analysis demonstrated small prosthesis size, urgent operation, PPM, female gender, and NYHA Class IV as significant predictors of mortality. Multivariate regression identified female gender, PPM, and urgent operation as the key independent predictors of mortality.Conclusion: PPM and female gender are significant predictors of mortality. Care should be taken to prevent PPM by implanting larger prosthesis especially in females.

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Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01506-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Lytfi Krasniqi ◽

Mads P. Kronby ◽

Lars P. S. Riber

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Significant Risk ◽

Valve Prosthesis ◽

Term Survival ◽

Long Term Survival ◽

All Cause Mortality

Abstract Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.

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Post hoc patient satisfaction with the choice of valve prosthesis for aortic valve replacement: results of a single-centre survey

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivab069 ◽

2021 ◽

Author(s):

Laure Bryssinck ◽

Siel De Vlieger ◽

Katrien François ◽

Thierry Bové

Keyword(s):

Patient Satisfaction ◽

Aortic Valve ◽

Confidence Interval ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Odds Ratio ◽

Mechanical Valve ◽

Decisional Conflict ◽

Valve Prosthesis ◽

Post Hoc

Abstract OBJECTIVES Our goal was to examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement (AVR). METHODS We surveyed 113 patients who were operated on for AVR at 60–70 years of age, including 74 patients with a mechanical valve (MECH) and 39 with a bioprosthesis (BIO). The study focused on quality of life and the decision pathway in relation to prosthesis choice and valve-related complications. Decisional conflict was defined as the post hoc uncertainty perceived by patients regarding their choice of prosthesis. RESULTS The survey was performed at a median of 5.2 (3.2–8.1) years after the AVR. Patients with a biological valve were older (BIO: 68.4 years [66.2–69.4] vs MECH: 63.9 [61.9–66.7]; P < 0.001). Global post hoc satisfaction with prosthesis choice was high in both groups (MECH: 95.9%; BIO: 100%), and 85.1% (MECH) and 92.3% (BIO) of them would repeat their choice. Conflict about their decision was equal (MECH: 30.3%; BIO: 32.6%) for different reasons: MECH patients experienced more anticoagulation-related inconvenience (25.9% vs 0%), fear of bleeding (31.1% vs 0%) and prosthesis noise (26.2% vs 0%), whereas more BIO patients feared prosthesis failure (39.7% vs 17.4%) or reoperation (43.5% vs 18.1%). Active involvement in the decision (odds ratio 0.37, 95% confidence interval 0.16–0.85; P = 0.029) and adequate information about the prosthesis (odds ratio 0.34, 95% confidence interval 0.14–0.86; P = 0.020) decreased the risk of conflict about the decision. CONCLUSIONS Although 30% of the responders showed a decisional conflict related to prosthesis-specific interferences, global patient satisfaction with the prosthesis choice for AVR is excellent. Increasing the patient’s involvement in the prosthesis choice through shared accountability and improved information is recommended to decrease the choice-related uncertainty.

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Comparison of Self-Expanding RDV Perceval S versus TAVI ACURATE neo/TF

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1722692 ◽

2021 ◽

Author(s):

Victor Mauri ◽

Stephen Gerfer ◽

Elmar Kuhn ◽

Matti Adam ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Implantation Rate ◽

Paravalvular Leak ◽

Short Term ◽

Cerebrovascular Events ◽

Transcatheter Heart Valve ◽

All Cause Mortality ◽

Rapid Deployment

Abstract Background Rapid deployment aortic valve replacement (RDAVR) and transcatheter aortic valve implantation (TAVI) have emerged as increasingly used alternatives to conventional aortic valve replacement to treat patients at higher surgical risk. Therefore, in this single-center study, we retrospectively compared clinical outcomes and hemodynamic performance of two self-expanding biological prostheses, the sutureless and rapid deployment valve (RDV) Perceval-S (PER) and the transcatheter heart valve (THV) ACURATE neo/TF (NEO) in a 1:1 propensity-score-matching (PSM) patient cohort. Methods A total of 332 consecutive patients with symptomatic aortic valve stenosis underwent either singular RDAVR with PER (119) or TAVI with NEO (213) at our institutions between 2012 and 2017. To compare the unequal patient groups, a 1:1 PSM for preoperative data and comorbidities was conducted. Afterward, 59 patient pairs were compared with regard to relevant hemodynamic parameter, relevant paravalvular leak (PVL), permanent postoperative pacemaker (PPM) implantation rate, and clinical postoperative outcomes. Results Postoperative clinical short-term outcomes presented with slightly higher rates for 30-day all-cause mortality (PER = 5.1% vs. NEO = 1.7%, p = 0.619) and major adverse cardiocerebral event in PER due to cerebrovascular events (transient ischemic attack [TIA]-PER = 3.4% vs. TIA-NEO = 1.7%, p = 0.496 and Stroke-PER = 1.7% vs. Stroke-NEO = 0.0%, p = 1). Moreover, we show comparable PPM rates (PER = 10.2% vs. NEO = 8.5%, p = 0.752). However, higher numbers of PVL (mild—PER = 0.0% vs. NEO = 55.9%, p = 0.001; moderate or higher—PER = 0.0% vs. NEO = 6.8%, p = 0.119) after TAVI with NEO were observed. Conclusion Both self-expanding bioprostheses, the RDV-PER and THV-NEO provide a feasible option in elderly and patients with elevated perioperative risk. However, the discussed PER collective showed more postoperative short-term complications with regard to 30-day all-cause mortality and cerebrovascular events, whereas the NEO showed higher rates of PVL.

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Pericarbon Pericardial Valve Prosthesis: Midterm Results of the Aortic Valve Replacement

Angiology ◽

10.1177/000331979804900101 ◽

1998 ◽

Vol 49 (1) ◽

pp. 1-11 ◽

Cited By ~ 4

Author(s):

Jan W. Borowiec ◽

Thomas W. Dubiel ◽

Hans-Erik Hansson ◽

Johan Landelius ◽

Sven-Olov Nyström ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Valve Prosthesis ◽

Midterm Results

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Minimally invasive redo aortic valve replacement with a sutureless valve implant

10.1510/mmcts.2021.008 ◽

2021 ◽

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Valve Prosthesis ◽

Mechanical Prosthesis ◽

Invasive Approach ◽

Replacement Procedure ◽

Aortic Valve Prosthesis ◽

Sutureless Valve

Reoperations for a dysfunctional mechanical aortic valve prosthesis are usually performed with a repeat sternotomy. Reopening the chest may be associated with a heart structure tear, bleeding, excessive transfusion, and a possible unfavorable outcome. Experience performing a redo aortic valve replacement with a minimally invasive approach and avoiding lysis of the pericardial adhesions is growing. We describe a redo aortic valve replacement procedure performed because of subvalvular pannus formation in a patient with a mechanical prosthesis. A partial J-shaped hemisternotomy at the 3rd intercostal space was performed; the ascending aorta was exposed and the valve was replaced with a sutureless bioprosthesis. The video tutorial shows the surgical approach, cardiopulmonary bypass solutions, and sutureless valve deployment.

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