scholarly journals PATIENT-PROSTHESIS MISMATCH IS A PREVENTABLE DISEASE BUT HOW TO PREVENT IT IS A STORY NOT YET WRITTEN

2020 ◽  
Author(s):  
Antonio Calafiore ◽  
Antonio Totaro ◽  
Stefano Guarracini ◽  
Sotirios Prapas ◽  
Massimo Di Marco ◽  
...  
Keyword(s):  
Task Force ◽  
Mean Value ◽  
Effective Orifice Area ◽  
Essential Information ◽  
Orifice Area ◽  
Biological Prosthesis ◽  
Patient Prosthesis Mismatch ◽  
Weak Points ◽  
The Mean ◽  
Severe Patient

Large studies demonstrated that moderate or severe patient-prosthesis mismatch (PPM) occurs in 44.2% to 65% of patients undergoing aortic valve replacement. If there is general agreement that patients with PPM have worse outcome than patients without, it is difficult to understand how to prevent this dangerous complication. The formula used to calculate the effective orifice area (EOA) of an implanted aortic prosthesis has many weak points that produce inconsistent results using the same prosthetic valve (type and size). The observed EOA (3 to 6 months postoperatively) of a #23 biological prosthesis can range from 0.9 to 3.5 cm², making PPM prevention impossible using projected EOA, where only the mean value is reported (1.83 cm² for the same #23 biological prosthesis). An EACTS-STS-AATS Valve Labelling Task Force has been established to suggest the manufacturers to present essential information on valvular prosthesis characteristics in standardized Valve Charts. For valves used in the aortic position, Valve Charts should include a standardized PPM chart to assess the probability of PPM after implantation. This will not solve completely the conundrum of prevention, but most likely it will be a step ahead.

Validity of identifying patient-prosthesis mismatch from the indexed effective orifice area

2008 ◽  
Vol 11 (3) ◽  
pp. 163-164 ◽  
Author(s):  
Yoshimasa Sakamoto ◽  
Kazuhiro Hashimoto ◽  
Hiroshi Okuyama ◽  
Shinichi Ishii ◽  
Noriyasu Kawada ◽  
...  
Keyword(s):  
Effective Orifice Area ◽  
Orifice Area ◽  
Patient Prosthesis Mismatch

scholarly journals Bioprosthetic Valve Fracture During Valve-in-valve TAVR: Bench to Bedside

2017 ◽  
Vol 13 (01) ◽  
pp. 20 ◽  
Author(s):  
John T Saxon ◽  
Keith B Allen ◽  
David J Cohen ◽  
Adnan K Chhatriwalla ◽  
◽  
...  
Keyword(s):  
Effective Means ◽  
Evidence Base ◽  
Bioprosthetic Valve ◽  
Current Evidence ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Transcatheter Heart Valve ◽  
Current Evidence Base ◽  
Patient Prosthesis Mismatch ◽  
Valve In Valve

Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) has been established as a safe and effective means of treating failed surgical bioprosthetic valves (BPVs) in patients at high risk for complications related to reoperation. Patients who undergo VIV TAVR are at risk of patient—prosthesis mismatch, as the transcatheter heart valve (THV) is implanted within the ring of the existing BPV, limiting full expansion and reducing the maximum achievable effective orifice area of the THV. Importantly, patient—prosthesis mismatch and high residual transvalvular gradients are associated with reduced survival following VIV TAVR. Bioprosthetic valve fracture (BVF) is as a novel technique to address this problem. During BPV, a non-compliant valvuloplasty balloon is positioned within the BPV frame, and a high-pressure balloon inflation is performed to fracture the surgical sewing ring of the BPV. This allows for further expansion of the BPV as well as the implanted THV, thus increasing the maximum effective orifice area that can be achieved after VIV TAVR. This review focuses on the current evidence base for BVF to facilitate VIV TAVR, including initial bench testing, procedural technique, clinical experience and future directions.

scholarly journals The Mosaic Mitral Valve Bioprosthesis: A Long-Term Clinical and Hemodynamic Follow-Up

2016 ◽  
Vol 43 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Michele Celiento ◽  
Stefania Blasi ◽  
Andrea De Martino ◽  
Stefano Pratali ◽  
Aldo D. Milano ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Nyha Class ◽  
Effective Orifice Area ◽  
Structural Failure ◽  
Actuarial Survival ◽  
Orifice Area ◽  
The Mean

We reviewed the cases of 100 patients (mean age, 73 ± 10 yr; 64 men) who had mitral valve replacement with a Medtronic Mosaic porcine bioprosthesis from 1995 through 2011. The mean New York Heart Association (NYHA) class was 3 ± 0.7, and 52 patients were in atrial fibrillation. Prosthetic sizes were chiefly 27 mm (50 patients) and 29 mm (40 patients). Follow-up ended in December 2012 and is 97% complete, with a cumulative duration of 611 patient-years (mean duration, 6 ± 4.6 yr; maximum, 17.7 yr). The early mortality rate was 10% (6% in elective patients); late deaths occurred in 31 patients (5 valve-related). Actuarial survival rates at 5, 10, and 15 years were 74% ± 5%, 50% ± 6%, and 37% ± 8%. The mean NYHA class in survivors was 1.4 ± 0.6 (P <0.0001). Thromboembolic episodes occurred in 4 patients, with an actuarial freedom at 15 years of 91% ± 5%. No cases of endocarditis were observed. Four patients needed reoperation, 2 for structural failure, and 1 each for perivalvular leakage and valve thrombosis. Actuarial freedom from structural failure and from reoperation, respectively, was 93% ± 5% and 91% ± 5% at 15 years. Echocardiographic follow-up in 24 patients with 27-mm prostheses showed a mean gradient of 5 ± 1.7 mmHg and an effective orifice area of 1.57 ± 0.3 cm2; in 16 patients with 29-mm prostheses, the mean gradient was 4.5 ± 1.9 mmHg, and the effective orifice area, 1.63 ± 0.4 cm2. During nearly 17 years of follow-up, the Mosaic bioprosthesis has shown good overall clinical and hemodynamic performance after mitral valve replacement.

Reconsideration of Patient-Prosthesis Mismatch Definition From the Valve Indexed Effective Orifice Area

2010 ◽  
Vol 89 (6) ◽  
pp. 1951-1955 ◽  
Author(s):  
Yoshimasa Sakamoto ◽  
Michio Yoshitake ◽  
Hirokuni Naganuma ◽  
Noriyasu Kawada ◽  
Katsushi Kinouchi ◽  
...  
Keyword(s):  
Effective Orifice Area ◽  
Orifice Area ◽  
Patient Prosthesis Mismatch

Incidence and predictors of mismatch after mechanical mitral valve replacement

2019 ◽  
Vol 27 (7) ◽  
pp. 535-541
Author(s):  
Ashraf AH El Midany ◽  
Ezzeldin A Mostafa ◽  
Tamer Hikal ◽  
Mostafa G Elbarbary ◽  
Ayman Doghish ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Patient Prosthesis Mismatch

Background Patient-prosthesis mismatch after mitral valve replacement has an unfavorable postoperative hemodynamic outcome, which underlines the importance of identifying and preventing prosthesis- and patient-related risk factors. This study was conducted to determine the incidence and identify possible predictors of patient-prosthesis mismatch. Methods A prospective study was conducted on 715 patients with a mean age of 42 ± 11 years who underwent mechanical mitral valve replacement between 2013 and 2017. The effective orifice area of the prostheses was estimated by the continuity equation, and a mismatch was defined as an effective orifice area index ≤1.2 cm2·m−2. The mean clinical and echocardiographic follow-up was 26.74 ± 11.58 months. Multivariate regression analysis was performed to identify predictors of patient-prosthesis mismatch. Results Patient-prosthesis mismatch was detected in 382 (53.4%) patients. A small mechanical prosthesis (<27 mm) was inserted in 54.3%. Mortality during follow-up was 9% (65 patients). Patient-prosthesis mismatch was identified in patients with preoperative rheumatic mitral valve pathology, associated tricuspid regurgitation, higher New York Heart Association class, preoperative atrial fibrillation, mitral stenosis, and small preoperative left ventricular dimensions. Multivariate analysis identified mitral stenosis, preoperative atrial fibrillation, and small postoperative left ventricular end-diastolic dimension as risk factors for patient-prosthesis mismatch. Conclusion Patient-prosthesis mismatch is a common sequela after mechanical mitral valve replacement. Identification of predictors of patient-prosthesis mismatch can help so that a preoperative strategy can be implemented to avoid its occurrence.

SIMULATION OF A CLOSED LOOP MODEL EQUIVALENT ELECTRONIC OF NORMAL CARDIOVASCULAR SYSTEM AND VALVULAR AORTIC STENOSIS

2020 ◽  
Vol 20 (01) ◽  
pp. 1950074
Author(s):  
AMINA HALAIMI ◽  
BOUALEM CHETTI ◽  
BOUALEM LARIBI ◽  
OMAR LABBADLIA
Keyword(s):  
Aortic Stenosis ◽  
Pressure Gradient ◽  
Effective Orifice Area ◽  
Loop Model ◽  
Orifice Area ◽  
Electrical Analogy ◽  
Mean Pressure ◽  
Valvular Aortic Stenosis ◽  
The Mean ◽  
Good Agreement

This work presents a developed zero-dimensional cardiovascular (CV) system model, based on an electrical analogy, with a detailed compartmental description of the heart and the main vascular circulation which is able to simulate normal and diseased conditions of CV system, especially the stenosis valvular aortic. To know the effect of each parameter on hemodynamics, the number of parameters is increased by adding more segments. The developed model consists of 14 compartments. The results show that the severity of aortic stenosis (AS) effect varies with the effective orifice area and the mean pressure gradient for the case of no AS; the effective orifice area is 4[Formula: see text]cm2 and the mean pressure gradient is 0[Formula: see text]mmHg, while for the case of mild AS, the effective orifice area is 1.5[Formula: see text]cm2 and the mean pressure gradient is 27.24[Formula: see text]mmHg. For the case of moderate AS, the effective orifice area is 1.0[Formula: see text]cm2 and the mean pressure gradient is 44.68[Formula: see text]mmHg. For the case of the severe AS, the effective orifice area is 0.61[Formula: see text]cm2 and the mean pressure gradient is 77.51[Formula: see text]mmHg. It is found that the developed model can estimate an accurate value of the effective orifice area for any value of mean pressure gradient in AS. The results obtained for the CV system under normal and diseased conditions show a good agreement compared to published results.

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.

scholarly journals A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli

2021 ◽  
Vol 10 (5) ◽  
pp. 1063
Author(s):  
Do Jung Kim ◽  
Sak Lee ◽  
Hyun-Chel Joo ◽  
Young-Nam Youn ◽  
Kyung-Jong Yoo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Left Ventricular ◽  
Propensity Score Matching Analysis ◽  
Retrospective Comparison ◽  
Confounding Variables ◽  
Patient Prosthesis Mismatch ◽  
The Mean ◽  
Post Implantation ◽  
Over Time ◽  
Severe Patient

The Trifecta valve has externally mounted leaflets; it differs from classic internally mounted valves (e.g., Carpentier-Edwards [C-E]). We evaluated post-implantation hemodynamics and clinical outcomes of these bioprostheses in small aortic annuli. From January 2015 to April 2019, 490 patients who underwent aortic valve replacement (AVR) were reviewed retrospectively. Altogether, 183 patients received 19 or 21 mm diameter C-E (n = 121) or Trifecta (n = 62) prostheses. To minimize confounding variables, we performed propensity-score matching analysis. The mean transvalvular pressure gradient (TVPG) was significantly lower in the Trifecta than in the C-E group at discharge (12.9 ± 4.8 vs. 15.0 ± 5.3 mmHg, p = 0.044). TVPG change over time was not significantly different between groups (p = 0.357). Left ventricular mass index decreased postoperatively (reduction: C-E, 28.1%; Trifecta, 30.1%, p = 0.879). No late mortality, severe patient–prosthesis mismatch, moderate-to-severe paravalvular leakage, structural valve degeneration, or valve thromboses were observed. Freedom from valve-related events at 3 years were similar for C-E (97.9% ± 2.1%) and Trifecta (97.7% ± 2.2%) patients (log-rank p = 0.993). Bioprosthesis design for small annuli significantly affected TVPG immediately after AVR. However, hemodynamics over time and clinical outcomes did not differ between the two designs.

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