May 27, 2006European Journal of Cardio-Thoracic Surgery187 citationsOpen Access
View Full PaperPatient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement☆
Key Result
Moderate patient prosthesis mismatch significantly increased in-hospital mortality compared to no mismatch (10.6% vs 6.9%; OR 1.4, p=0.018) and was independently predictive of long-term mortality.
Study Design
Type
Cohort (n=4,131)
Structured PICO
Does patient prosthesis mismatch increase short- and long-term mortality in patients undergoing aortic valve replacement?
P
Population
4,131 patients who underwent aortic valve replacement (AVR) between May 1996 and April 2004 (1,856 received bileaflet mechanical AVR and 2,275 stented xenograft AVR)
I
Intervention
Patient prosthesis mismatch (PPM), defined as severe (effective orifice area/body surface area <0.65 cm²/m²) or moderate (0.65-0.85 cm²/m²)
C
Comparator
No patient prosthesis mismatch
O
Outcome
Short- and long-term mortality (including in-hospital mortality)hard clinical
Moderate patient prosthesis mismatch is present in a quarter of patients undergoing aortic valve replacement and independently predicts short- and long-term mortality.
Main Result
Effect estimate: OR 1.4
Absolute Event Rate: 10.6% vs 6.9%
p-value: p=0.018
Abstract
OBJECTIVE: The aim of this study was to evaluate the impact of patient prosthesis mismatch (PPM) and additional risk factors on outcome after aortic valve replacement (AVR). METHODS: Four thousand one hundred and thirty-one patients who were operated between May 1996 and April 2004 were evaluated. One thousand eight hundred and fifty-six patients received bileaflet mechanical AVR and 2275 stented xenograft AVR. PPM was defined as severe if manufacturers effective orifice area (EOA) divided by body surface area (BSA) was 70 years (n=1589, p=0.002, OR 1.85), emergency indication (n=374, p10 (n=494, p<0.001, OR 4.7) and additional cardiac procedures (n=2049, p<0.001, OR 2.0) as predictors for adverse outcome after AVR. CONCLUSION: Severe PPM is rare; moderate PPM is present in a quarter of patients. PPM has a significant impact on short- and long-term mortality after AVR.