Aortic valve prosthesis-patient mismatch and long-term outcomes: 19-year single-center experience

Autor: Robert A. Baker, Waleed Aty, Phillip J. Tully, Gregory D. Rice, John L. Knight, Jayme Bennetts
Rok vydání: 2012
Předmět:
Pulmonary and Respiratory Medicine
Adult
Male
medicine.medical_specialty
Time Factors
Single Center
Prosthesis Design
Risk Assessment
Severity of Illness Index
Cohort Studies
Postoperative Complications
Aortic valve replacement
Interquartile range
Internal medicine
Prosthesis Fitting
Confidence Intervals
Odds Ratio
Medicine
Humans
Hospital Mortality
Aged
Retrospective Studies
Body surface area
Aged
80 and over
Bioprosthesis
Heart Valve Prosthesis Implantation
business.industry
Patient Selection
Hazard ratio
Aortic Valve Stenosis
Middle Aged
medicine.disease
Confidence interval
Surgery
Prosthesis Failure
Survival Rate
medicine.anatomical_structure
Logistic Models
Treatment Outcome
Echocardiography
Concomitant
Heart Valve Prosthesis
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Artery
Follow-Up Studies
Zdroj: The Annals of thoracic surgery. 96(3)
ISSN: 1552-6259
Popis: The clinical effects of prosthesis-patient mismatch (PPM) after aortic valve replacement, with respect to morbidity and survival, remain controversial, particularly in high-risk patient subgroups.Patients undergoing aortic valve replacement from January 1992 to December 2010 were classified according to effective orifice area index into severe PPM (effective orifice area index0.65 cm²/m²), moderate PPM (effective orifice area index 0.65 to 0.85 cm²/m²), and absent PPM (effective orifice area index0.85 cm²/m²). Analyses examined major morbidity and total all-cause death.Prosthesis-patient mismatch was classified as severe (92 of 1,060; 8.7%), moderate (440 of 1,060; 41.5%), or absent (528 of 1,060; 49.8%). Moderate and severe PPM were unrelated to in-hospital morbidity or mortality. There were 440 deaths (41.5%) at 5.6 years median follow-up (interquartile range, 2.9 to 9.1). Trend toward poorer survival according to PPM group (χ2=5.46; p=0.07) was attenuated further with covariate adjustment. Sensitivity analyses demonstrated discrete mortality effects for moderate PPM in association with concomitant coronary artery bypass grafting, impaired left ventricular function, and older age (significant hazard ratios range, 1.05 to 1.57). Severe PPM also increased mortality risk in association with older age, concomitant coronary artery bypass grafting, and New York Heart Association Class III or IV (significant hazard ratios range, 1.06 to 2.65).Prosthesis-patient mismatch was not associated with mortality in covariate-adjusted models. However, a discrete mortality risk was attributable to moderate and severe PPM in patients of older age, or those with left ventricular dysfunction, New York Heart Association class III or IV, and concomitant coronary artery bypass grafting.
Databáze: OpenAIRE
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