Key result
Prosthesis-patient mismatch after mitral valve replacement increased mortality risk, while postoperative left atrial dimension ≥52.9 mm predicted late atrial fibrillation recurrence.
Why the study?
Does prosthesis-patient mismatch impact late recurrence of atrial fibrillation and clinical outcomes in patients undergoing mitral valve replacement with a cryomaze procedure?
Cohort (n=142)
No
Does prosthesis-patient mismatch impact late recurrence of atrial fibrillation and clinical outcomes in patients undergoing mitral valve replacement with a cryomaze procedure?
Effect estimate: OR 1.91 (95% CI 0.36-11.14)
p-value: p=0.4
Prosthesis-patient mismatch after mitral valve replacement with cryomaze is associated with higher transmitral gradients, leading to late left atrial enlargement and increased risk of atrial fibrillation recurrence and heart failure admission.
Prosthesis-patient mismatch may increase mortality after mitral replacement with cryomaze; leaves open whether avoiding mismatch reduces atrial fibrillation recurrence.
BACKGROUND: This study investigated the impact of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) with cryoablation using a maze procedure. METHODS AND RESULTS: We evaluated 142 patients who underwent MVR with a cryomaze procedure. Echocardiography was performed at 1 week and at 1, 3, 5, 7, and 10 years. An effective orifice area index of 1.2 cm(2)/m(2)was used to define PPM. Mean transmitral pressure gradient (mean MPG) >5 mmHg was defined as high. PPM was a risk for overall mortality and a predictor of admission for heart failure. Mean MPG at 1 week was significantly higher in PPM patients (4.8 ± 1.5 mmHg vs. 3.7 ± 1.2 mmHg, P<0.001). Left atrium (LA) dimension decreased after the operation and did not change in patients without high mean MPG, while it increased after 7 years in patients with high mean MPG. The significant predictor of AF recurrence after 1 year was LA dimension ≥ 52.9 mm. Yearly AF recurrence was 10.6% in patients with LA dimension ≥ 52.9 mm, and 1.8% in the others. In patients with high mean MPG, tricuspid regurgitation pressure gradient (TRPG), related to pulmonary artery pressure, was increased after 7 years. CONCLUSIONS: PPM is a risk for late mortality, admission for heart failure, and high mean MPG, while the last was related to risk of enlargement of LA and increase of TRPG after 7 years. LA dimension after surgery is a predictor of late recurrence of AF, especially when ≥ 52.9 mm.
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Sato et al. (2014) conducted a cohort in Atrial fibrillation and mitral valve disease (n=142). Prosthesis-patient mismatch (PPM) vs. No prosthesis-patient mismatch was evaluated on Late survival (overall mortality) (OR 1.91, 95% CI 0.36-11.14, p=0.4). Prosthesis-patient mismatch after mitral valve replacement increased mortality risk, while postoperative left atrial dimension ≥52.9 mm predicted late atrial fibrillation recurrence.
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