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Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study

OBJECTIVE: “Patient-prosthesis mismatch” (PPM) after aortic valve replacement (AVR) has been reported to increase morbidity and mortality. Although algorithms have been developed to avoid PPM, factors favouring its occurrence have not been well defined. DESIGN AND SETTING: This was a prospective coh...

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Autores principales: Bonderman, Diana, Graf, Alexandra, Kammerlander, Andreas A., Kocher, Alfred, Laufer, Guenter, Lang, Irene M., Mascherbauer, Julia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849375/
https://www.ncbi.nlm.nih.gov/pubmed/24312608
http://dx.doi.org/10.1371/journal.pone.0081940
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author Bonderman, Diana
Graf, Alexandra
Kammerlander, Andreas A.
Kocher, Alfred
Laufer, Guenter
Lang, Irene M.
Mascherbauer, Julia
author_facet Bonderman, Diana
Graf, Alexandra
Kammerlander, Andreas A.
Kocher, Alfred
Laufer, Guenter
Lang, Irene M.
Mascherbauer, Julia
author_sort Bonderman, Diana
collection PubMed
description OBJECTIVE: “Patient-prosthesis mismatch” (PPM) after aortic valve replacement (AVR) has been reported to increase morbidity and mortality. Although algorithms have been developed to avoid PPM, factors favouring its occurrence have not been well defined. DESIGN AND SETTING: This was a prospective cohort study performed at the Medical University of Vienna. PATIENTS: 361 consecutive patients who underwent aortic valve replacement for isolated severe aortic stenosis were enrolled. MAIN OUTCOME MEASURES: Patient- as well as prosthesis-related factors determining the occurrence of moderate and severe PPM (defined as effective orifice area indexed to body surface area ≤ 0.8 cm(2)/m(2)) were studied. RESULTS: Postoperatively, 172 patients (48%) were diagnosed with PPM. The fact that predominantly female patients were affected (58% with PPM diagnosis in women versus 36% in men, p<0.001) was explained by the finding that they had smaller aortic root diameters (30.5±4.7 mm versus 35.3±4.2 mm, p<0.0001) and a higher proportion of bioprosthetic valves (82% versus 62%, p<0.0001), both independent predictors of PPM (aortic root diameter: OR 0.009 [95% CI, 0.004;0.013]; p = 0.0003, presence of bioprosthetic valve: OR 0.126 [95% CI, 0.078;0.175]; p<0.0001). CONCLUSIONS: The occurrence of PPM is determined by aortic root diameter and prosthesis type. Novel sutureless bioprostheses with optimized hemodynamic performance or transcatheter aortic valves may become a promising alternative to conventional bioprosthetic valves in the future.
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spelling pubmed-38493752013-12-05 Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study Bonderman, Diana Graf, Alexandra Kammerlander, Andreas A. Kocher, Alfred Laufer, Guenter Lang, Irene M. Mascherbauer, Julia PLoS One Research Article OBJECTIVE: “Patient-prosthesis mismatch” (PPM) after aortic valve replacement (AVR) has been reported to increase morbidity and mortality. Although algorithms have been developed to avoid PPM, factors favouring its occurrence have not been well defined. DESIGN AND SETTING: This was a prospective cohort study performed at the Medical University of Vienna. PATIENTS: 361 consecutive patients who underwent aortic valve replacement for isolated severe aortic stenosis were enrolled. MAIN OUTCOME MEASURES: Patient- as well as prosthesis-related factors determining the occurrence of moderate and severe PPM (defined as effective orifice area indexed to body surface area ≤ 0.8 cm(2)/m(2)) were studied. RESULTS: Postoperatively, 172 patients (48%) were diagnosed with PPM. The fact that predominantly female patients were affected (58% with PPM diagnosis in women versus 36% in men, p<0.001) was explained by the finding that they had smaller aortic root diameters (30.5±4.7 mm versus 35.3±4.2 mm, p<0.0001) and a higher proportion of bioprosthetic valves (82% versus 62%, p<0.0001), both independent predictors of PPM (aortic root diameter: OR 0.009 [95% CI, 0.004;0.013]; p = 0.0003, presence of bioprosthetic valve: OR 0.126 [95% CI, 0.078;0.175]; p<0.0001). CONCLUSIONS: The occurrence of PPM is determined by aortic root diameter and prosthesis type. Novel sutureless bioprostheses with optimized hemodynamic performance or transcatheter aortic valves may become a promising alternative to conventional bioprosthetic valves in the future. Public Library of Science 2013-12-03 /pmc/articles/PMC3849375/ /pubmed/24312608 http://dx.doi.org/10.1371/journal.pone.0081940 Text en © 2013 Bonderman et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Bonderman, Diana
Graf, Alexandra
Kammerlander, Andreas A.
Kocher, Alfred
Laufer, Guenter
Lang, Irene M.
Mascherbauer, Julia
Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study
title Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study
title_full Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study
title_fullStr Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study
title_full_unstemmed Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study
title_short Factors Determining Patient-Prosthesis Mismatch after Aortic Valve Replacement – A Prospective Cohort Study
title_sort factors determining patient-prosthesis mismatch after aortic valve replacement – a prospective cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849375/
https://www.ncbi.nlm.nih.gov/pubmed/24312608
http://dx.doi.org/10.1371/journal.pone.0081940
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