scholarly journals Early outcomes of patient-prosthesis mismatch following aortic valve replacement

Perfusion ◽  
2021 ◽  
pp. 026765912110232
Author(s):  
Serik Aitaliyev ◽  
Egle Rumbinaitė ◽  
Karolina Mėlinytė-Ankudavičė ◽  
Rokas Nekrošius ◽  
Vytenis Keturakis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Daily Practice ◽  
Effective Orifice Area ◽  
Concomitant Surgery ◽  
Early Results ◽  
Large Patient ◽  
Patient Prosthesis Mismatch

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.

scholarly journals Early Hemodynamics after Aortic Valve Replacement

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 674
Author(s):  
Serik Aitaliyev ◽  
Egle Rumbinaitė ◽  
Karolina Mėlinytė-Ankudavičė ◽  
Rokas Nekrošius ◽  
Vytenis Keturakis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Mechanical Valve ◽  
Early Postoperative Period ◽  
Effective Orifice Area ◽  
Concomitant Surgery ◽  
Mechanical Valves ◽  
Patient Prosthesis Mismatch ◽  
Study Population

Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with different types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients who presented with indications for aortic valve replacement (AVR) with/without concomitant surgery from March 2019 to January 2020. The study population included 90 (60%) men and 60 (40%) women (mean age, 67.33 ± 10.22 years; range, 37–88 years). Echocardiography data such as peak and mean transprosthetic pressure gradients (Gmax, Gmean), velocity (V), effective orifice area (EOA), and indexed EOA (iEOA) were derived at rest and after exercise at baseline and before discharge. The study patients performed the six-minute walk test (6MWT) on the 5th–7th postoperative day. Results: Stented tissue valves showed excellent performance at rest and after exercise in comparison with mechanical valves, which showed favorable hemodynamics at rest only. At the time of discharge, moderate PPM was observed in 7/74 patients (9.5%) at rest and 5/98 (3.3%) patients after exercise. None of the patients showed severe PPM. EOA and iEOA were not significantly different between the groups. However, the stented group showed more pronounced changes in EOA and iEOA after exercise, whereas the changes in the mechanical valve group did not reach significance. Conclusions: In the early postoperative period, mechanical valves and stented valves showed favorable resting hemodynamics. The PPM rate measured after exercise was lower than that at rest.

scholarly journals Early Results after Aortic Valve Replacement Using Last Generation Bioprosthetic Aortic Valve

2021 ◽  
Vol 24 (6) ◽  
pp. E598-E962
Author(s):  
Dritan Useini ◽  
Markus Schlömicher ◽  
Peter Haldenwang ◽  
Hamid Naraghi ◽  
Vadim Moustafine ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Paravalvular Leakage ◽  
Concomitant Surgery ◽  
Early Results ◽  
The Mean ◽  
Few Data

Introduction: Few data are available about the newest generation surgical bioprosthesis. We aimed to evaluate early clinical and hemodynamic outcomes after using the INSPIRIS RESILIA aortic valve (Edwards Lifesciences, Irvine, California, USA). Methods: Between July 2018 and April 2021, 80 patients underwent aortic valve replacement receiving the INSPIRIS RESILIA aortic valve at our institution. Primary outcomes were the composite of early mortality, stroke, and myocardial infarction. Secondary outcomes were hemodynamic performances of the valve, paravalvular leakage, and new pacemaker implantation. Results: The mean age of the study population was 60.6 ± 8.3 years. The mean Society of Thoracic Surgery-Predicted Risk of Mortality score was 2.9 ± 1.7%. In 43.7% of the patients, concomitant surgery was performed. The in-hospital mortality, all-stroke, and myocardial infarction rates were 2.5%, 1.2%, and 1.2%, respectively. No valve was explanted and no redo was performed. The mean postoperative trans-prosthetic gradient at discharge was 10.2 ± 4.1 mm Hg. There was no need for new pacemaker implantation. We registered only two cases with minimal (trace) paravalvular leakage. Conclusion: The use of the INSPIRIS RESILIA aortic valve in a young, low-risk population is safe and associated with very good early clinical and hemodynamic outcomes.

scholarly journals Long-Term Survival Following Aortic Valve Replacement: the Influence of Age, Prosthesis-Patient Mismatch and Indexed Effective Orifice Area

2017 ◽  
Vol 11 ◽  
Author(s):  
Alexander Manché ◽  
Aaron Casha ◽  
Liberato Camilleri
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Statistical Significance ◽  
Effective Orifice Area ◽  
Term Survival ◽  
Orifice Area ◽  
Long Term Survival ◽  
Risk Of Death

<p><strong>Background</strong></p><p>Prosthesis-patient mismatch (PPM) has been linked to reduced long-term survival after aortic valve replacement. We studied the influence of age, PPM and indexed effective orifice area (iEOA) in this setting.</p><p> </p><p><strong>Methods</strong></p><p>Patients (n=586) subjected to aortic valve replacement were followed up for a mean of 7.8 years (maximum 20 years). The study population was divided into four equivalent groups according to age. Mortality data was extracted from the National Statistics database. Data pertaining to patient body surface area and valve effective orifice area was collected prospectively and mismatch (moderate or severe) was defined according to established values. The Cox proportional hazard model was used to study the effect of age, mismatch and iEOA on survival. The Log Rank test was used to compare survival curves by age groups.</p><p> </p><p><strong>Results</strong></p><p>The incidence of moderate PPM was 24.6%, and of severe PPM 3.9%. Mismatch increased the hazard of death by 31.2% for moderate PPM and 70.3% for severe PPM but did not reach statistical significance. Mean age of patients with mismatch (n=167) was 2.52 years less than in those without (63.35±10.61 versus 65.87±11.69, p=0.016). Age significantly affected survival, increasing the risk of death by 7.3% for every incremental year. <em> </em>Mean iEOA was 0.94±0.15cm<sup>2</sup>/m<sup>2</sup>; for every 0.1unit increase in iEOA the risk of death decreased by 8.8%.</p><p> </p><p><strong>Conclusion</strong></p><p>Long-term survival was significantly affected by age at operation.  Although mismatch increased hazard of death the effect did not reach statistical significance. A larger iEOA had a significant beneficial effect on survival.<em></em></p>

Patient-prosthesis mismatch following aortic valve replacement

Heart ◽  
2019 ◽  
Vol 105 (Suppl 2) ◽  
pp. s28-s33 ◽  
Author(s):  
Rajdeep Bilkhu ◽  
Marjan Jahangiri ◽  
Catherine M Otto
Keyword(s):  
Renal Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Cardiac Symptoms ◽  
Patient Prosthesis Mismatch

Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.

Abstract 16029: Patient Prosthesis Mismatch Post Transcatheter Aortic Valve Replacement is Associated With Lack of Improved Left Ventricular Diastolic Function

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ashvita Ramesh ◽  
Andrew C Peters ◽  
Fei Fei Gong ◽  
Madeline Jankowski ◽  
Eric Cantey ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Diastolic Function ◽  
Valve Replacement ◽  
Cardiac Remodeling ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Transcatheter Aortic Valve ◽  
Patient Prosthesis Mismatch

Background: Patient prosthesis mismatch (PPM) is a frequent problem after transcatheter aortic valve replacement (TAVR) that results in adverse cardiac remodeling. This study sought to evaluate the association between PPM and changes in diastolic function post-TAVR. Methods: 339 patients (79.3+8.8 y, 44.4% female) who underwent TAVR for severe aortic stenosis between 2015-2018 with an echocardiogram (echo) at baseline and at 1-year were studied. Echo measurements were performed according to ASE guidelines. Moderate PPM is defined by an indexed effective orifice area (iEOA) of <0.85 to >0.65 cm 2 /m 2 , and severe PPM by an iEOA <0.65 cm 2 /m 2 . The aortic valve acceleration to ejection time ratio (AT/ET) was measured to further stratify patients with PPM and considered abnormal if >0.35. Student’s t-tests were used to compare diastolic function at baseline and 1-year. Results: We found that 26.2% of subjects had moderate PPM, 11.8% had severe PPM, and 8.3% had an AT/ET >0.35 (Table 1). Tissue velocity at both the medial and lateral mitral annulus was reduced at baseline and did not improve. Left atrial pressure (LAP) as assessed by E/e` improved in those without PPM (19.5+9.5 to 18.8+9.6, p=0.04) and those with moderate PPM (21+12.2 to 18.2+6.9, p=0.03), but not in those with severe PPM or with AT/ET>0.35. Right ventricular systolic pressure (RVSP) decreased significantly in patients with no or moderate PPM (39.6+13.6 mmHg to 35.5+10.8 mmHg, p=0.02 and 41.2+13.9 mmHg to 36+10.8 mmHg, p=0.006; respectively), while there was no significant decrease for patients with severe PPM or with AT/ET>0.35. Conclusion: We found that in patients undergoing TAVR, diastolic function was impaired as evidenced by low mitral tissue velocities, elevated LAP, and elevated RVSP. PPM resulted in less improvement of diastolic parameters including no improvement in LAP and RVSP. These findings suggest that severe PPM has an adverse effect on cardiac remodeling.

Impact of Patient-Prosthesis Mismatch following Aortic Valve Replacement on Long-Term Survival and Quality of Life

2018 ◽  
Vol 68 (02) ◽  
pp. 124-130 ◽  
Author(s):  
Grischa Hoffmann ◽  
Selam Abraham-Westphal ◽  
Tim Attmann ◽  
Derk Frank ◽  
Georg Lutter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Term Survival ◽  
Long Term Survival ◽  
Patient Prosthesis Mismatch ◽  
The Impact

Abstract Background The impact of patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) on long-term survival and quality of life (QoL) remains controversial. The objective of this study was to evaluate the impact of PPM on long-term survival and QoL in a large cohort of patients treated with isolated stented biological AVR in a single-center experience. Methods We analyzed data of 632 consecutive patients following isolated stented biological AVR between 2007 and 2012 at our institution. We evaluated the QoL (393 evaluable patients) using the Short Form 12-item Health Survey (SF-12) questionnaire via telephone call and the impact of PPM on long-term survival (533 evaluable patients) by Kaplan–Meier's estimate. Results Severe PPM (<0.65 cm2/m2) had a negative impact on physical component summary (PCS) score (SF-12) compared with patients with moderate or no PPM (p = 0.014), while the mental component summary (MCS) score (SF-12) was not affected by the degree of PPM (p = 0.133). Long-term survival was not different among the three different PPM groups investigated (p = 0.75). Conclusion Severity of PPM demonstrated no influence on long-term survival and MCS score (SF-12), but it was associated with a lower PCS score (SF-12) in patients with severe PPM.

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