What question did this study set out to answer?

To evaluate the impact of prosthesis-patient mismatch, measured as the ratio of prosthetic valve 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?

Population

2,154 patients who underwent aortic valve replacement with stented bioprostheses between 1976 and 1996 and…

Comparison

Prosthesis-patient mismatch, defined as an… vs No prosthesis-patient mismatch, defined as an…

Design

Cohort

Follow-up

12 years

Authors

VRVivek RaoUniversity of Delhi WJW.R. Eric JamiesonDartmouth College JIJoan IvanovInterventional / Structural Cardiology

Discussion

Member takes

Implication

PPM associated with higher AVR mortality; hypothesis-generating for avoidance strategies pending randomized confirmation.

Key Points

To evaluate the impact of prosthesis-patient mismatch, measured as the ratio of prosthetic valve effective orifice area to body surface area, on early and long-term survival after aortic valve replacement.
Follow-up was conducted on 2,981 patients who underwent aortic valve replacement with stented bioprostheses between 1976 and 1996.
The ratio of prosthetic valve effective orifice area to body surface area (EOA/BSA) was calculated in 2,154 patients.
Patients were categorized into a Small group (lowest decile, EOA/BSA <0.75 cm²/m², n=227) and a control group (EOA/BSA >0.75 cm²/m², n=1,927).
Operative mortality was significantly higher in the Small group than in the control group (8% vs. 5%, P=0.03).
Actuarial 12-year overall survival was 50±5% in the Small group versus 49±2% in controls (P=0.27), but freedom from valve-related mortality was significantly lower in the Small group (75±5% vs. 84±2%, P=0.004).
Multivariate Cox regression identified advanced age and an EOA/BSA <0.75 cm²/m² 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 an effective orifice area (EOA) to body surface area (BSA) ratio of <0.75 cm2/m2 (n=227)

Comparator

No prosthesis-patient mismatch, defined as an EOA/BSA ratio of >0.75 cm2/m2 (n=1927)

Outcome

Overall mortality and valve-related mortality at 12 yearshard clinical

Prosthesis-patient mismatch (EOA/BSA <0.75 cm2/m2) during aortic valve replacement with stented bioprostheses is associated with increased operative and long-term valve-related mortality.

Cite This Study

Rao et al. (2000) studied this question.

synapsesocial.com/papers/6a74635fb74a11b511a7fd65 https://doi.org/10.1161/circ.102.suppl_3.iii-5

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Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Prosthesis-Patient Mismatch Affects Survival After Aortic Valve Replacement

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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