Cargando…

Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study

BACKGROUND: Reoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR (re-AVR; AVR after prior AVR). We describe the clinical outcomes and incidence of prosthesis-patient mismatches (PPM)...

Descripción completa

Detalles Bibliográficos
Autores principales: Tsubota, Hideki, Sakaguchi, Genichi, Marui, Akira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104489/
https://www.ncbi.nlm.nih.gov/pubmed/32228628
http://dx.doi.org/10.1186/s13019-020-01094-2
_version_ 1783512245708259328
author Tsubota, Hideki
Sakaguchi, Genichi
Marui, Akira
author_facet Tsubota, Hideki
Sakaguchi, Genichi
Marui, Akira
author_sort Tsubota, Hideki
collection PubMed
description BACKGROUND: Reoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR (re-AVR; AVR after prior AVR). We describe the clinical outcomes and incidence of prosthesis-patient mismatches (PPM) after reoperative AVR. METHODS: Among 113 patients who underwent reoperative AVR between 2007 and 2018, 44 underwent re-AVR and 69 underwent a first replacement of a diseased natural valve after any cardiac surgery except AVR (primary AVR). We then compared early and late outcomes, the impact of re-AVR on the effective orifice areas (EOA), and the incidence and influence of PPM on reoperative AVR. RESULTS: Hospital mortality was 2.7%, and the overall 1-, 3-, and 5-year survival rates were 95, 91 and 86%, respectively. The reference EOA of the newly implanted valve was smaller than that of the previous valve (1.4 ± 0.3 vs. 1.6 ± 0.3 cm(2), p < 0.01). The mean pressure gradient was greater (15.2 ± 6.4 vs. 12.7 ± 6.2 mmHg, p = 0.04) and indexed EOA was smaller (0.92 ± 0.26 vs. 1.06 ± 0.36 cm(2)/m(2), p = 0.04) during re-AVR than primary AVR, whereas the incidence of PPM was similar (38.7% vs. 34.8%, p = 0.87) between the groups. CONCLUSIONS: The clinical outcomes of reoperative AVR were acceptable. Although the reference EOA of new implanted valves was smaller than that of previous valves, re-AVR did not increase the incidence of PPM. These findings might serve as a guide for future decisions regarding the surgical approach to treating degenerated prosthetic valves.
format Online
Article
Text
id pubmed-7104489
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-71044892020-03-31 Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study Tsubota, Hideki Sakaguchi, Genichi Marui, Akira J Cardiothorac Surg Research Article BACKGROUND: Reoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR (re-AVR; AVR after prior AVR). We describe the clinical outcomes and incidence of prosthesis-patient mismatches (PPM) after reoperative AVR. METHODS: Among 113 patients who underwent reoperative AVR between 2007 and 2018, 44 underwent re-AVR and 69 underwent a first replacement of a diseased natural valve after any cardiac surgery except AVR (primary AVR). We then compared early and late outcomes, the impact of re-AVR on the effective orifice areas (EOA), and the incidence and influence of PPM on reoperative AVR. RESULTS: Hospital mortality was 2.7%, and the overall 1-, 3-, and 5-year survival rates were 95, 91 and 86%, respectively. The reference EOA of the newly implanted valve was smaller than that of the previous valve (1.4 ± 0.3 vs. 1.6 ± 0.3 cm(2), p < 0.01). The mean pressure gradient was greater (15.2 ± 6.4 vs. 12.7 ± 6.2 mmHg, p = 0.04) and indexed EOA was smaller (0.92 ± 0.26 vs. 1.06 ± 0.36 cm(2)/m(2), p = 0.04) during re-AVR than primary AVR, whereas the incidence of PPM was similar (38.7% vs. 34.8%, p = 0.87) between the groups. CONCLUSIONS: The clinical outcomes of reoperative AVR were acceptable. Although the reference EOA of new implanted valves was smaller than that of previous valves, re-AVR did not increase the incidence of PPM. These findings might serve as a guide for future decisions regarding the surgical approach to treating degenerated prosthetic valves. BioMed Central 2020-03-30 /pmc/articles/PMC7104489/ /pubmed/32228628 http://dx.doi.org/10.1186/s13019-020-01094-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Tsubota, Hideki
Sakaguchi, Genichi
Marui, Akira
Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study
title Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study
title_full Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study
title_fullStr Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study
title_full_unstemmed Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study
title_short Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study
title_sort incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104489/
https://www.ncbi.nlm.nih.gov/pubmed/32228628
http://dx.doi.org/10.1186/s13019-020-01094-2
work_keys_str_mv AT tsubotahideki incidenceandinfluenceofprosthesispatientmismatchafterreoperativeaorticvalvereplacementaretrospectivesinglecenterstudy
AT sakaguchigenichi incidenceandinfluenceofprosthesispatientmismatchafterreoperativeaorticvalvereplacementaretrospectivesinglecenterstudy
AT maruiakira incidenceandinfluenceofprosthesispatientmismatchafterreoperativeaorticvalvereplacementaretrospectivesinglecenterstudy