Patient-prosthesis mismatch and reduction in left ventricular mass after aortic valve replacement

TY - JOUR

T1 - Patient-prosthesis mismatch and reduction in left ventricular mass after aortic valve replacement

AU - Kandler, Kristian

AU - Møller, Christian H

AU - Hassager, Christian

AU - Olsen, Peter S

AU - Lilleør, Nikolaj

AU - Steinbrüchel, Daniel A

PY - 2013/7

Y1 - 2013/7

N2 - Background: The presence of patient-prosthesis mismatch (PPM) after aortic valve replacement may influence patient survival. We examined the relationship between PPM and changes in left ventricular mass index at 3 months follow-up and also overall survival. Methods: From patients included in the Mosaic trial, we studied data from 266 patients who underwent aortic valve replacement with the Medtronic Mosaic porcine bioprosthesis and had an echocardiography performed 3 months postoperatively. Complete echocardiographic data, to calculate left ventricular mass index, was available in 78% of the patients. The primary outcome for this substudy was prevalence and severity of PPM. Secondary outcomes were reduction in left ventricular mass index at 3 months follow-up and medium-term survival. Patients without PPM were defined as having an indexed effective orifice area greater than 0.85 cm2/m2, and those with moderate and severe PPM as having an indexed effective orifice area between 0.65 cm2/m2 and 0.85 cm2/m2 or below 0.65 cm2/m2, respectively. Results: PPM was found in 217 (82%) patients. No difference in overall survival was found between patients with PPM and those without PPM. The change in left ventricular mass index was significantly different between groups (no PPM -31.4 ± 28.0 g/m2, moderate PPM 1.1 ± 34.4 g/m2, and severe PPM -5.9 ± 29.7 g/m2, respectively (p = 0.01). Conclusions: The presence of PPM did not influence medium-term survival. However, patients without PPM showed a marked reduction in left ventricular mass index as soon as 3 months postoperatively.

AB - Background: The presence of patient-prosthesis mismatch (PPM) after aortic valve replacement may influence patient survival. We examined the relationship between PPM and changes in left ventricular mass index at 3 months follow-up and also overall survival. Methods: From patients included in the Mosaic trial, we studied data from 266 patients who underwent aortic valve replacement with the Medtronic Mosaic porcine bioprosthesis and had an echocardiography performed 3 months postoperatively. Complete echocardiographic data, to calculate left ventricular mass index, was available in 78% of the patients. The primary outcome for this substudy was prevalence and severity of PPM. Secondary outcomes were reduction in left ventricular mass index at 3 months follow-up and medium-term survival. Patients without PPM were defined as having an indexed effective orifice area greater than 0.85 cm2/m2, and those with moderate and severe PPM as having an indexed effective orifice area between 0.65 cm2/m2 and 0.85 cm2/m2 or below 0.65 cm2/m2, respectively. Results: PPM was found in 217 (82%) patients. No difference in overall survival was found between patients with PPM and those without PPM. The change in left ventricular mass index was significantly different between groups (no PPM -31.4 ± 28.0 g/m2, moderate PPM 1.1 ± 34.4 g/m2, and severe PPM -5.9 ± 29.7 g/m2, respectively (p = 0.01). Conclusions: The presence of PPM did not influence medium-term survival. However, patients without PPM showed a marked reduction in left ventricular mass index as soon as 3 months postoperatively.

U2 - 10.1016/j.athoracsur.2013.03.089

DO - 10.1016/j.athoracsur.2013.03.089

M3 - Journal article

C2 - 23684157

SN - 0003-4975

VL - 96

SP - 66

EP - 71

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

IS - 1

ER -