Journal of Cardiothoracic Surgery | |
Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement | |
Albert H van Straten2  Jan-Melle van Dantzig1  Kathinka C Peels1  Massimo A Mariani3  Wobbe Bouma3  Mohamed A Soliman Hamad2  Bart M Koene3  | |
[1] Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands;Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands;Department of Cardiothoracic Surgery, University Medical Center Groningen, Groningen, The Netherlands | |
关键词: Survival analysis; Statistics; Prosthesis-patient mismatch; Replacement; Aortic valve; Heart valves; Prosthesis; | |
Others : 825780 DOI : 10.1186/1749-8090-8-96 |
|
received in 2013-02-19, accepted in 2013-04-09, 发布年份 2013 | |
![]() |
【 摘 要 】
Background
The influence of prosthesis-patient mismatch (PPM) on survival after aortic valve replacement (AVR) remains controversial. In this study, we sought to determine the effect of PPM on early (≤30 days) and late mortality (>30 days) after AVR or AVR combined with coronary artery bypass grafting (AVR with CABG).
Methods
Between January 1998 and March 2012, 2976 patients underwent AVR (n= 1718) or AVR with CABG (n=1258) at a single institution. PPM was defined as an indexed effective orifice area (EOAI) ≤0.85 cm2/m2 and patients were divided into two groups based on the existence of PPM. Cumulative probability values of survival were estimated with Kaplan-Meier method and compared between groups using Breslow test. Univariate and multivariate independent predictors of early mortality were identified using logistic regression. Cox proportional-hazard regression analysis was used to determine univariate and multivariate independent predictors of late mortality.
Results
Early mortality was 6.7% in the PPM group vs 4.7% in the group with no PPM (p=0.013). Late mortality for the PPM group at 1, 5 and 10 years was 4%, 16% and 43%, respectively. Late mortality for the group with no PPM at 1, 5 and 10 years was 4%, 15% and 33% respectively. Independent predictors of early mortality included age, severely impaired left ventricular (LV) function, endocarditis, renal dysfunction, chronic obstructive pulmonary disease (COPD) and cardiopulmonary bypass (CPB) time. Multivariate independent predictors of late mortality included age, severely impaired LV function, diabetes, peripheral vascular disease (PVD), renal dysfunction, history of a cerebrovascular accident (CVA), CPB time and a history of previous cardiac surgery. PPM was not an independent predictor of early or late mortality.
Conclusion
PPM is not an independent predictor of both early and late mortality after AVR or AVR combined with CABG.
【 授权许可】
2013 Koene et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20140713073732383.pdf | 451KB | ![]() |
|
Figure 1. | 59KB | Image | ![]() |
【 图 表 】
Figure 1.
【 参考文献 】
- [1]Pibarot P, Dumesnil JG: Prosthesis-patient mismatch: definition, clinical impact, and prevention. Heart 2006, 92:1022-1029.
- [2]Tasca G, Brunelli F, Cirillo M, DallaTomba M, Mhagna Z, Troise G, Quaini E: Impact of valve prosthesis-patient mismatch on left ventricular mass regression following aortic valve replacement. Ann Thorac Surg 2005, 79:505-510.
- [3]Rao V, Jamieson WR, Ivanov J, Armstrong S, David TE: Prosthesis-patient mismatch affects survival after aortic valve replacement. Circulation 2000, 102:III5-9.
- [4]Blais C, Dumesnil JG, Baillot R, Simard S, Doyle D, Pibarot P: Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation 2003, 108:983-988.
- [5]Tasca G, Mhagna Z, Perotti S, Centurini PB, Sabatini T, Amaducci A, Brunelli F, Cirillo M, Dalla Tomba M, Quaini E: Impact of prosthesis-patient mismatch on cardiac events and midterm mortality after aortic valve replacement in patients with pure aortic stenosis. Circulation 2006, 113:570-576.
- [6]Walther T, Rastan A, Falk V, Lehmann S, Garbade J, Funkat AK, Mohr FW, Gummert JF: Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement. Eur J Cardiothorac Surg 2006, 30:15-19.
- [7]Medalion B, Blackstone EH, Lytle BW, White J, Arnold JH, Cosgrove DM: Aortic valve replacement: is valve size important? J Thorac Cardiovasc Surg 2000, 119:963-974.
- [8]Frapier JM, Rouviere P, Razcka F, Aymard T, Albat B, Chaptal PA: Influence of patient-prosthesis mismatch on long-term results after aortic valve replacement with a stented bioprosthesis. J Heart Valve Dis 2002, 11:543-551.
- [9]Flameng W, Meuris B, Herijgers P, Herregods MC: Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valve. Ann Thorac Surg 2006, 82:530-536.
- [10]Moon MR, Pasque MK, Munfakh NA, Melby SJ, Lawton JS, Moazami N, Codd JE, Crabtree TD, Barner HB, Damiano RJ Jr: Prosthesis-patient mismatch after aortic valve replacement: impact of age and body size on late survival. Ann Thorac Surg 2006, 81:481-488. discussion 489
- [11]Monin JL, Monchi M, Kirsch ME, Petit-Eisenmann H, Baleynaud S, Chauvel C, Metz D, Adams C, Quere JP, Gueret P, Tribouilloy C: Low-gradient aortic stenosis: impact of prosthesis-patient mismatch on survival. Eur Heart J 2007, 28:2620-2626.
- [12]Nozohoor S, Nilsson J, Luhrs C, Roijer A, Sjogren J: The influence of patient-prosthesis mismatch on in-hospital complications and early mortality after aortic valve replacement. J Heart Valve Dis 2007, 16:475-482.
- [13]Mascherbauer J, Rosenhek R, Fuchs C, Pernicka E, Klaar U, Scholten C, Heger M, Wollenek G, Maurer G, Baumgartner H: Moderate patient-prosthesis mismatch after valve replacement for severe aortic stenosis has no impact on short-term and long-term mortality. Heart 2008, 94:1639-1645.
- [14]Howell NJ, Keogh BE, Barnet V, Bonser RS, Graham TR, Rooney SJ, Wilson IC, Pagano D: Patient-prosthesis mismatch does not affect survival following aortic valve replacement. Eur J Cardiothorac Surg 2006, 30:10-14.
- [15]Monin JL: Prosthesis-patient mismatch: myth or reality? Heart 2009, 95:948-952.
- [16]Bleiziffer S, Ali A, Hettich IM, Akdere D, Laubender RP, Ruzicka D, Boehm J, Lange R, Eichinger W: Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement. Heart 2010, 96:865-871.
- [17]Mohty D, Dumesnil JG, Echahidi N, Mathieu P, Dagenais F, Voisine P, Pibarot P: Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesity, and left ventricular dysfunction. J Am Coll Cardiol 2009, 53:39-47.
- [18]Urso S, Sadaba R, Aldamiz-Echevarria G: Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement? Interact Cardiovasc Thorac Surg 2009, 9:510-518.
- [19]Yap CH, Mohajeri M, Yii M: Prosthesis-patient mismatch is associated with higher operative mortality following aortic valve replacement. Heart Lung Circ 2007, 16:260-264.
- [20]Hernandez-Vaquero D, Llosa JC, Diaz R, Khalpey Z, Morales C, Alvarez R, Lopez J, Boye F: Impact of patient-prosthesis mismatch on 30-day outcomes in young and middle-aged patients undergoing aortic valve replacement. J Cardiothorac Surg 2012, 7:46. BioMed Central Full Text
- [21]Kohsaka S, Mohan S, Virani S, Lee VV, Contreras A, Reul GJ, Coulter SA: Prosthesis-patient mismatch affects long-term survival after mechanical valve replacement. J Thorac Cardiovasc Surg 2008, 135:1076-1080.
- [22]Howell NJ, Keogh BE, Ray D, Bonser RS, Graham TR, Mascaro J, Rooney SJ, Wilson IC, Pagano D: Patient-prosthesis mismatch in patients with aortic stenosis undergoing isolated aortic valve replacement does not affect survival. Ann Thorac Surg 2010, 89:60-64.
- [23]Hong S, Yi G, Youn YN, Lee S, Yoo KJ, Chang BC: Effect of the prosthesis-patient mismatch on long-term clinical outcomes after isolated aortic valve replacement for aortic stenosis: a prospective observational study. J Thorac Cardiovasc Surg 2012.
- [24]Jamieson WR, Ye J, Higgins J, Cheung A, Fradet GJ, Skarsgard P, Germann E, Chan F, Lichtenstein SV: Effect of prosthesis-patient mismatch on long-term survival with aortic valve replacement: assessment to 15 years. Ann Thorac Surg 2010, 89:51-58. discussion 59
- [25]Cotoni DA, Palac RT, Dacey LJ, O'Rourke DJ: Defining patient-prosthesis mismatch and its effect on survival in patients with impaired ejection fraction. Ann Thorac Surg 2011, 91:692-699.
- [26]Urso S, Sadaba R, Monleon-Getino T, Aldamiz-Echevarria G: [Moderate patient-prosthesis mismatch has no independent effect on 30-day mortality after isolated aortic valve replacement]. Rev Esp Cardiol 2010, 63:409-414.
- [27]Kato Y, Suehiro S, Shibata T, Sasaki Y, Hirai H: Impact of valve prosthesis-patient mismatch on long-term survival and left ventricular mass regression after aortic valve replacement for aortic stenosis. J Card Surg 2007, 22:314-319.
- [28]Vicchio M, Della Corte A, De Santo LS, De Feo M, Caianiello G, Scardone M, Cotrufo M: Prosthesis-patient mismatch in the elderly: survival, ventricular mass regression, and quality of life. Ann Thorac Surg 2008, 86:1791-1797.