What question did this study set out to answer?

To determine the impact of prosthesis-patient mismatch, assessed by the ratio of effective orifice area to body surface area, on early and long-term survival after aortic valve replacement.

November 7, 2000Circulation

Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement

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Why the study?

Does prosthesis-patient mismatch (EOA/BSA <0.75 cm2/m2) increase mortality in patients undergoing aortic valve replacement with stented bioprostheses?

Key Points

To determine the impact of prosthesis-patient mismatch, assessed by the ratio of effective orifice area to body surface area, on early and long-term survival after aortic valve replacement.
Followed 2,981 patients who underwent aortic valve replacement with stented bioprostheses between 1976 and 1996.
Calculated the effective orifice area to body surface area (EOA/BSA) ratio in 2,154 patients, defining mismatch as the lowest decile (<0.75 cm²/m², n=227) compared with controls (>0.75 cm²/m², n=1,927).
Evaluated operative mortality, 12-year actuarial survival, and valve-related mortality using multivariate Cox regression analysis.
Operative mortality was significantly higher in the mismatch group than in the control group (8% vs. 5%, P=0.03).
Freedom from valve-related mortality at 12 years was significantly lower in the mismatch group (75±5% vs. 84±2%, P=0.004), while overall 12-year survival did not differ significantly (50±5% vs. 49±2%, P=0.27).
Multivariate Cox regression identified EOA/BSA <0.75 cm²/m² and advanced age as independent predictors of valve-related mortality.

Structured PICO

Does prosthesis-patient mismatch (EOA/BSA <0.75 cm2/m2) increase mortality in patients undergoing aortic valve replacement with stented bioprostheses?

Population

2,154 patients who underwent aortic valve replacement (AVR) with stented bioprostheses between 1976 and 1996 and had recorded body surface area (BSA)

Intervention

Prosthesis-patient mismatch, defined as a prosthetic valve effective orifice area (EOA) to body surface area (BSA) ratio of <0.75 cm2/m2

Comparator

No prosthesis-patient mismatch, defined as an EOA/BSA ratio of >0.75 cm2/m2

Outcome

Long-term overall survival and valve-related mortalityhard clinical

Prosthesis-patient mismatch (EOA/BSA <0.75 cm2/m2) is associated with significantly higher early operative and late valve-related mortality after bioprosthetic aortic valve replacement.

Discussion

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Implication

PPM was associated with higher operative and late valve-related mortality after bioprosthetic AVR; leaves open whether mismatch avoidance improves survival in randomized trials.

Cite This Study

Rao et al. (2000) studied this question.

synapsesocial.com/papers/69fea890c28c7d12f5f0cbbc https://doi.org/10.1161/01.cir.102.suppl_3.iii-5

Topics

Valvular heart disease

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Implication

PPM was associated with higher operative and late valve-related mortality after bioprosthetic AVR; leaves open whether mismatch avoidance improves survival in randomized trials.

Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement

Key Points

Structured PICO

Discussion

Implication

Cite This Study

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Topics

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