Key result
Patient-prosthesis mismatch occurred in 8.5% of patients undergoing isolated aortic valve replacement and was not significantly associated with increased short-term mortality (3.9% vs 2.2%, p=0.076).
Why the study?
Does patient-prosthesis mismatch affect short-term mortality and major morbidity in patients undergoing isolated aortic valve replacement?
Cohort (n=3,609)
Yes
Does patient-prosthesis mismatch affect short-term mortality and major morbidity in patients undergoing isolated aortic valve replacement?
Absolute Event Rate: 3.9% vs 2.2%
p-value: p=0.076
In Japanese patients undergoing isolated aortic valve replacement, patient-prosthesis mismatch is associated with increased postoperative morbidity (longer ventilation and ICU stay) but is not an independent risk factor for short-term mortality.
PPM should not yet alter prosthesis selection in isolated AVR; leaves open its impact on morbidity and long-term outcomes.
OBJECTIVE: Patient-prosthesis mismatch (PPM) may affect clinical outcomes in patients with aortic valve replacement (AVR). We retrospectively examined the PPM in patients with isolated AVR in the Japan Adult Cardiovascular Surgery Database (JACVSD). METHODS: We examined all patients with isolated AVR between January 1, 2008 and December 31, 2009. The JACVSD data collection form has a total of 255 variables. We defined PPM as an effective orifice area index of ≤ 0.85 m(2)/cm(2). RESULTS: PPM was observed in 306 of 3,609 cases analyzed, PPM rate was 8.5 %. Body surface area was larger and body mass index was higher in the PPM group than the non-PPM group (P < 0.001). Patients with PPM were older (P = 0.001) and had a higher prevalence of diabetes (P = 0.004), dyslipidemia (P < 0.001), hypertension (P < 0.001), cerebrovascular disease (P = 0.031), old myocardial infarction (P = 0.006), previous percutaneous coronary artery intervention (P = 0.001), coronary artery disease (P = 0.018), and aortic valve stenosis (P < 0.001). Perioperative blood transfusion (P < 0.001) and dialysis (P = 0.005) were more frequent in the PPM group. Postoperative ventilation (P = 0.004) and intensive care unit stay (P = 0.004) were significantly longer in the PPM group. CONCLUSIONS: Age, aortic valve stenosis, dyslipidemia, hypertension, old myocardial infarction, previous percutaneous coronary artery intervention, diabetes mellitus, cerebrovascular disease, and high body mass index were the risk factors for PPM. PPM was not an independent risk factor for short-term mortality.
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Kaminishi et al. (2013) conducted a cohort in Aortic valve replacement (n=3,609). Patient-prosthesis mismatch (PPM) vs. Non-PPM was evaluated on Short-term mortality (p=0.076). Patient-prosthesis mismatch occurred in 8.5% of patients undergoing isolated aortic valve replacement and was not significantly associated with increased short-term mortality (3.9% vs 2.2%, p=0.076).
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