Key result
Latest generation prostheses linked to ~50% lower rates of moderate prosthesis-patient mismatch versus older models.
Why the study?
Most studies about prosthesis-patient mismatch were conducted before the introduction of new high-performance prostheses, and the current impact of these new prostheses on PPM is unclear.
Does the use of latest generation supra-annular prostheses reduce prosthesis-patient mismatch and mortality in patients undergoing aortic valve replacement?
Cohort (n=743)
Does the use of latest generation supra-annular prostheses reduce prosthesis-patient mismatch and mortality in patients undergoing aortic valve replacement?
Latest generation supra-annular prostheses reduce the incidence of prosthesis-patient mismatch, a significant predictor of late cardiac mortality in AVR patients.
Answers are grounded in this paper and cite their sources.
Newer prostheses may halve moderate PPM rates; Level 4 cohorts leave open whether this improves survival in high-LVMI patients.
Most studies about prosthesis-patient mismatch (PPM) were conducted before the introduction of new high-performance prostheses. Nowadays, PPM could become unfrequent. Our aim was to study the impact of new prostheses on PPM in comparison with previous experience. Prosthetic Indexed Effective Orifice Area (EOAi) was estimated in two historical cohorts. Group A: 339 patients undergoing AVR from Mar 94-Nov 01. Group B: 404 operated on during the last three years when latest generation prostheses were implanted. Incidence, determinants of PPM and clinical results were studied. Moderate PPM (EOAi <or=0.85 cm(2)/m(2)) was present in 38% and 19% (respective groups). Mean EOAi increased from 1.02+/-0.29 cm(2)/m(2) to 1.11+/-0.27 cm(2)/m(2). 'Group B' and 'new prostheses' were protective. Thirty-day mortality was 3.8% and 4.7% with higher rate in patients with increased left ventricular mass index (LVMI), especially if PPM was present: 14.7 vs. 2.1% (P<0.05) in Group A; 25.0 vs. 4.8% (P<0.05) in Group B (PPM vs. no-PPM). LVMI regression was impaired in these patients. Moderate PPM was an independent predictor of late cardiac mortality (OR: 3.38, 95% CI: 1.37-8.31; P<0.01). PPM is a prognostic factor for late cardiac death. Its impact on early mortality is only relevant in patients with high LVMI. Its incidence has decreased with the use of new prostheses.
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Fúster et al. (2007) conducted a cohort in Aortic valve replacement (n=743). Latest generation prostheses vs. Previous generation prostheses was evaluated on Moderate prosthesis-patient mismatch (EOAi ≤0.85 cm2/m2). Latest generation prostheses reduced the incidence of moderate prosthesis-patient mismatch to 19% compared to 38% with older prostheses, a condition that independently predicted late cardiac mortality.
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