Incidence and Impact of Patient-Prosthesis Mismatch in Isolated Aortic Valve Surgery

AIM: The mains topics of this work are the incidence of patient-prosthesis mismatch and the influence in the early results of isolated aortic valve surgery.METHODS: In 193 patients isolated aortic valve surgery was performed. The study population was divided in three subgroups: 20 patients with severe, 131 patients with moderate and 42 patients without patient-prosthesis mismatch. The indexed effective orifice area was used to define the subgroups. Operative mortality and perioperative complications were considered the indicators of the early results of aortic valve surgery.RESULTS: The incidence of severe and moderate patient-prosthesis mismatch was respectively 10.3% and 67.8%. Hospital mortality and perioperative complications were: mortality 5% vs. 3.1% vs. 2.4% (p = 0.855), low cardiac output 5% vs. 6.9% vs. 4.8% (p = 0.861); pulmonary complications 5% vs. 3.1 vs. 0.0% (p = 0.430); exploration for bleeding 5% vs. 0.8% vs. 2.4% (p = 0.319); atrial fibrillation 30% vs. 19.8% vs. 11.9% (p = 0.225); wound infection 5% vs. 0.8% vs. 0.00% (p = 0.165), respectively for the group with severe, moderate and without patient-prosthesis mismatch.CONCLUSIONS: Patient-prosthesis mismatch is a common occurrence in aortic valve surgery. This phenomenon does not affect the early results of aortic valve surgery.

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Abstract 17635: Can Published Reference Values Predict Patient-prosthesis Mismatch?

Circulation ◽

10.1161/circ.132.suppl_3.17635 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Prerna Bansal ◽

Muaz Abudiab ◽

Kalyan Chaliki ◽

Marella Punnaiah ◽

Hari Chaliki

Keyword(s):

Aortic Valve ◽

Reference Values ◽

Reference Value ◽

Valve Surgery ◽

Effective Orifice Area ◽

Aortic Valve Surgery ◽

Area Index ◽

True Incidence ◽

Advanced Planning ◽

Patient Prosthesis Mismatch

Background: Patient-prosthesis mismatch (PPM) is still a frequently encountered problem after aortic valve surgery for aortic stenosis(AS). Advanced planning for prevention of PPM would be beneficial. We hypothesized that identification of severe PPM based on chosen surgical valve will predict development of severe PPM after surgery. Methods: Fifty one patients (74±13yrs) with severe aortic valve stenosis who underwent aortic valve surgery had postoperative echocardiogram (TTE) within 6 months. Severe PPM was defined as effective orifice area index (EOAI)<0.65 cm2/m2.We calculated predicted severe PPM using published references values of the prosthetic valve. We used mean value and the values one standard deviation above and below. We compared these values to the actual PPM based on postoperative TTE. Results: All patients had severe AS (MG50±7 mm Hg) and an LV EF of 56±15%. Forty four patients had tissue valves implanted and 7 had mechanical valves implanted. Mean time between postoperative TTE and surgery was 39± 60 days. When the mean reference values for the valve implanted was used, only 1 patient (2%) was predicted to have severe PPM. However, based on postoperative TTE, 6 patients (13%) had severe PPM. There was no correlation between EOAI based on postop TTE and mean published reference values (Figure).When the EOAI below one SD of the published reference value was chosen, the predicted incidence of severe PPM was 38%. When the EOAI above one SD was chosen for the reference value none of the patients were predicted to have PPM. Sensitivity and specificity to identify severe PPM was 17% and 100% for mean published reference value while it was 0% and 100% for +1 SD and 83% and 68% for -1 SD. Conclusions: 1) Use of mean published reference values markedly under estimate the true incidence of post-operative PPM and has unacceptably low sensitivity. 2) Predicted occurrence of PPM was widely variable (0% to 38%) based on the published reference values. Larger studies are needed.

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Aortic Annulus Enlargement: Early and Long-Terms Results

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.006 ◽

2017 ◽

Vol 5 (1) ◽

pp. 23-26

Author(s):

Selman Dumani ◽

Ermal Likaj ◽

Laureta Dibra ◽

Vera Beca ◽

Saimir Kuci ◽

...

Keyword(s):

Aortic Valve ◽

Pulmonary Complications ◽

Valve Surgery ◽

Aortic Annulus ◽

Aortic Valve Surgery ◽

Low Cardiac Output ◽

Valve Pathology ◽

Severe Patient

AIM: Patient-prosthesis mismatch (PPM) is a common occurrence in aortic valve surgery. Even the discussions about the impact of this phenomenon on the results of aortic valve surgery, the management of this problem remain one of the main topics in this kind of surgery. One of the ways of a solution is aortic annulus enlargement. The main topic of this study is to evaluate the early and longterm results of this technique in our country.METHODS: During the period January 2010 –January 2015, 641 patients performed aortic valve surgery. In ten patients we performed aortic annulus enlargement according to Manouguian technique to avoid severe patient-prothesis mismatch.Operative mortality and perioperative complications (low cardiac output, pulmonary complications, etc..) were considered the indicators of the early results. Survival, clinical presentation according to NYHA, quality of life were the indicators to evaluate long-term results. Preoperative and postoperative echocardiographic data were also used to evaluate our results. We collected the data from hospital registrations and periodical clinical visit and echographic examination after hospital discharge.RESULTS: In our group, 6 of 10 patients were diagnosed with stenotic aortic valve, two patients had aortic valve regurgitation and two mixed valve pathology. Four patients had concomitant cardiac surgery procedure, mitral or CABG. In all cases, aortic valve pathology was the primary diagnose.In the preoperative echocardiographic examination mean transvalvular gradient was 54.3 ± 6.42.We had no death during early or late postoperative period. Only one patient had pulmonary complications and long time of respiratory assistance because of his pulmonary pathology.The same patient had low cardiac output and wound infection. Early after surgery mean transprostethic gradient was 16.2 ± 3.44 and late postoperative was 15.9 ± 4.3. No patient had the severe patient-prothesis mismatch. Mean follow-up was 49 ± 20.26 months. During follow-up, we had no death, and all patients had very good quality of life.CONCLUSIONS: Aortic valve annulus enlargement can be used with very good early and late results with the final goal to increase the potential benefit of the patient from surgery of aortic valve.

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Early outcomes of patient-prosthesis mismatch following aortic valve replacement

Perfusion ◽

10.1177/02676591211023286 ◽

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.

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Suture Techniques and Patient-Prosthesis Mismatch for Aortic Valve Surgery

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2020.03.064 ◽

2020 ◽

Vol 110 (5) ◽

pp. 1781 ◽

Cited By ~ 1

Author(s):

Sahin Iscan ◽

Bortecin Eygi ◽

Nihan Yesilkaya

Keyword(s):

Aortic Valve ◽

Valve Surgery ◽

Suture Techniques ◽

Aortic Valve Surgery ◽

Patient Prosthesis Mismatch

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Early Hemodynamics after Aortic Valve Replacement

Medicina ◽

10.3390/medicina56120674 ◽

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.

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Stent valve implantation in conventional redo aortic valve surgery to prevent patient–prosthesis mismatch

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivw397 ◽

2016 ◽

pp. ivw397 ◽

Cited By ~ 1

Author(s):

Enrico Ferrari ◽

Giorgio Franciosi ◽

Sara Clivio ◽

Francesco Faletra ◽

Marco Moccetti ◽

...

Keyword(s):

Aortic Valve ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Patient Prosthesis Mismatch ◽

Valve Implantation

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Redo aortic valve replacement with a non-conventional intraoperative decision to avoid left main stem obstruction.

10.22541/au.164181234.49649159/v1 ◽

2022 ◽

Author(s):

Thomas Theologou ◽

Depaksi Tare ◽

Sara Clivio ◽

Demertzis S ◽

Enrico Ferrari

Keyword(s):

Aortic Valve ◽

Coronary Flow ◽

Operative Time ◽

Valve Surgery ◽

Effective Orifice Area ◽

Aortic Valve Surgery ◽

Left Main ◽

Orifice Area ◽

Sapien 3 ◽

Coronary Ostia

Redo aortic valve surgery for failure of a previously implanted valve is always challenging. In case of small-sized implanted valves, the use of a balloon-expanding Sapien-3 valve can enhance the final effective orifice area, avoid complex annulus enlargement techniques, and can reduce operative time and morbidities. We describe a case where after explanting a failed 19mm St. Jude mechanical aortic valve and further deployment of a 23mm Sapien-3 valve, the left coronary ostia was obstructed by the skirt of the transcatheter prosthesis. After careful removal of a little part of the skirt, we were able to restore the coronary flow and the patient had a favorable outcome.

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