Incidence of prosthesis-patient mismatch and early postoperative outcome in elderly patients undergoing aortic valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Xing ,  WANG Wei

Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

WANG Wei, Email: drweiwang0728@hotmail.com

Keywords：

Prosthesis-patient mismatch; effective orifice area index; body surface area

DOI：

10.7507/1007-4848.201709077

Video：

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Objective To analyze the incidence of valve prosthesis-patient mismatch (PPM) and ventricular remodeling of elderly patients after aortic valve replacement (AVR). Methods We retrospectively analyzed the clinical data of 134 patient aged over 65 years who underwent AVR for the aortic stenosis or regurgitation at our hospital between January 2016 and December 2016. There were 73 males and 61 females aged 69.7±3.6 years ranging from 65-79 years. The clinical and ultrasound cardiography data were evaluated. PPM was defined as an effective orifice area index (EOAI) of ≤0.85 cm²/m². The incidence of PPM and the left ventricular remodeling after surgical AVR in the patients with aortic stenosis and aortic regurgitation was analyzed, and the outcomes of aortic valve mechanical prosthesis and aortic valve bioprosthesis were compared. Results The incidence of PPM was 32.5% in aortic stenosis and 13.0% in aortic regurgitation (P<0.05). One patient died in the early post-operation, and the incidence of severe PPM was 6.0%. Conclusion The incidence of PPM after AVR in the patients with aortic regurgitation is less than that in the patients with aortic stenosis.

Citation： ZHANG Xing, WANG Wei. Incidence of prosthesis-patient mismatch and early postoperative outcome in elderly patients undergoing aortic valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(8): 707-710. doi: 10.7507/1007-4848.201709077 Copy

1.	Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation, 1978, 58(1): 20-24.
2.	Blais C, Dumesnil JG, Baillot R, et al. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation, 2003, 108(8): 983-988.
3.	Auffret V, Voisine P, Cinq-Mars A, et al. Prevalence and impact of prosthesis-patient mismatch following surgical aortic valve replacement for pure aortic regurgitation. J Heart Valve Dis, 2016, 25(5): 543-551.
4.	Hu YM, Wu XL, Hu ZH, et al. Study of formula for calculating body surface areas of the Chinese adults. Sheng Li Xue Bao, 1999, 51(1): 45-48.
5.	Walther T, Rastan A, Falk V, et al. Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement. Eur J Cardiothorac Surg, 2006, 30(1): 15-19.
6.	Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol, 2000, 36(4): 1131-1141.
7.	Sakamoto Y, Hashimoto K. Update on aortic valve prosthesis-patient mismatch in Japan. Gen Thorac Cardiovasc Surg, 2013, 61(12): 669-675.
8.	Bach DS, Sakwa MP, Goldbach M, et al. Hemodynamics and early clinical performance of the St. Jude Medical Regent mechanical aortic valve. Ann Thorac Surg, 2002, 74(6): 2003-2009.
9.	Thomson DJ, Jamieson WR, Dumesnil JG, et al. Medtronic mosaic porcine bioprosthesis satisfactory early clinical performance. Ann Thorac Surg, 1998, 66(6 Suppl): S122-S125.
10.	Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation, 2009, 119(7): 1034-1048.
11.	Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation, 2000, 102(4): 470-479.
12.	Ding WH, Lam YY, Kaya MG, et al.Eehoear diographie predictors of left ventricular functional recovery following valve replacement surgery for severe aortic stenosis. Int J Cardiol, 2008, 128 (2): 178-184.
13.	Lamb HJ, Beyerbacht HP, de Roos A, et al. Left ventricular remodeling early after aortic valve replacement: diferential effects on diastolic function in aortic valve stenosis and aortic regurgitation. J Am Coll Cardiol, 2002, 40 (12): 2182-2188.
14.	Blais C, Dumesnil JG, Baillot R, et al. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation, 2003, 108(8): 983-988.
15.	Hoffmann G, Ogbamicael SA, Jochens A, et al. Impact of patient-prosthesis mismatch following aortic valve replacement on short-term survival: a retrospective single center analysis of 632 consecutive patients with isolated stented biological aortic valve replacement. Thorac Cardiovasc Surg, 2014, 62(6): 469-474.
16.	Sportelli E, Regesta T, Salsano A, et al. Does patient-prosthesis mismatch after aortic valve replacement affect survival and quality of life in elderly patients? J Cardiovasc Med (Hagerstown), 2016, 17(2): 137-143.
17.	Guo L, Zheng J, Chen L, et al. Impact of prosthesis-patient mismatch on short-term outcomes after aortic valve replacement: a retrospective analysis in East China. J Cardiothorac Surg, 2017, 12(1): 42.
18.	Sommers KE, David TE. Aortic valve replacement with patch enlargement of the aortic annulus. Ann Thorac Surg, 1997, 63(6): 1608-1612.
19.	Carrier M, Pellerin M, Perrault LP, et al. Experience with the 19-mm Carpentier-Edwards pericardial bioprosthesis in the elderly. Ann Thorac Surg, 2001, 71(5 Suppl): S249-S252.
20.	Sakamoto Y, Hashimoto K, Okuyama H, et al. Prevalence and avoidance of patient-prosthesis mismatch in aortic valve replacement in small adults. Ann Thorac Surg, 2006, 81(4): 1305-1309.

1. Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation, 1978, 58(1): 20-24.
2. Blais C, Dumesnil JG, Baillot R, et al. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation, 2003, 108(8): 983-988.
3. Auffret V, Voisine P, Cinq-Mars A, et al. Prevalence and impact of prosthesis-patient mismatch following surgical aortic valve replacement for pure aortic regurgitation. J Heart Valve Dis, 2016, 25(5): 543-551.
4. Hu YM, Wu XL, Hu ZH, et al. Study of formula for calculating body surface areas of the Chinese adults. Sheng Li Xue Bao, 1999, 51(1): 45-48.
5. Walther T, Rastan A, Falk V, et al. Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement. Eur J Cardiothorac Surg, 2006, 30(1): 15-19.
6. Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol, 2000, 36(4): 1131-1141.
7. Sakamoto Y, Hashimoto K. Update on aortic valve prosthesis-patient mismatch in Japan. Gen Thorac Cardiovasc Surg, 2013, 61(12): 669-675.
8. Bach DS, Sakwa MP, Goldbach M, et al. Hemodynamics and early clinical performance of the St. Jude Medical Regent mechanical aortic valve. Ann Thorac Surg, 2002, 74(6): 2003-2009.
9. Thomson DJ, Jamieson WR, Dumesnil JG, et al. Medtronic mosaic porcine bioprosthesis satisfactory early clinical performance. Ann Thorac Surg, 1998, 66(6 Suppl): S122-S125.
10. Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation, 2009, 119(7): 1034-1048.
11. Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation, 2000, 102(4): 470-479.
12. Ding WH, Lam YY, Kaya MG, et al.Eehoear diographie predictors of left ventricular functional recovery following valve replacement surgery for severe aortic stenosis. Int J Cardiol, 2008, 128 (2): 178-184.
13. Lamb HJ, Beyerbacht HP, de Roos A, et al. Left ventricular remodeling early after aortic valve replacement: diferential effects on diastolic function in aortic valve stenosis and aortic regurgitation. J Am Coll Cardiol, 2002, 40 (12): 2182-2188.
14. Blais C, Dumesnil JG, Baillot R, et al. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation, 2003, 108(8): 983-988.
15. Hoffmann G, Ogbamicael SA, Jochens A, et al. Impact of patient-prosthesis mismatch following aortic valve replacement on short-term survival: a retrospective single center analysis of 632 consecutive patients with isolated stented biological aortic valve replacement. Thorac Cardiovasc Surg, 2014, 62(6): 469-474.
16. Sportelli E, Regesta T, Salsano A, et al. Does patient-prosthesis mismatch after aortic valve replacement affect survival and quality of life in elderly patients? J Cardiovasc Med (Hagerstown), 2016, 17(2): 137-143.
17. Guo L, Zheng J, Chen L, et al. Impact of prosthesis-patient mismatch on short-term outcomes after aortic valve replacement: a retrospective analysis in East China. J Cardiothorac Surg, 2017, 12(1): 42.
18. Sommers KE, David TE. Aortic valve replacement with patch enlargement of the aortic annulus. Ann Thorac Surg, 1997, 63(6): 1608-1612.
19. Carrier M, Pellerin M, Perrault LP, et al. Experience with the 19-mm Carpentier-Edwards pericardial bioprosthesis in the elderly. Ann Thorac Surg, 2001, 71(5 Suppl): S249-S252.
20. Sakamoto Y, Hashimoto K, Okuyama H, et al. Prevalence and avoidance of patient-prosthesis mismatch in aortic valve replacement in small adults. Ann Thorac Surg, 2006, 81(4): 1305-1309.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Incidence of prosthesis-patient mismatch and early postoperative outcome in elderly patients undergoing aortic valve replacement

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