Surgical aortic valve replacement and patient-prosthesis mismatch: a meta-analysis of 108 182 patients.

OBJECTIVES: This study sought to evaluate the impact of patient-prosthesis mismatch (PPM) on the risk of perioperative, early-, mid- and long-term mortality rates after surgical aortic valve replacement. METHODS: Databases were searched for studies published until March 2018. The main outcomes of interest were perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality. RESULTS: The search yielded 3761 studies for inclusion. Of these, 70 articles were analysed, and their data were extracted. The total number of patients included was 108 182 who underwent surgical aortic valve replacement. The incidence of PPM after surgical aortic valve replacement was 53.7% (58 116 with PPM and 50 066 without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95% confidence interval (CI) 1.302-1.707; P < 0.001], 1-year mortality (OR 1.465, 95% CI 1.277-1.681; P < 0.001), 5-year mortality (OR 1.358, 95% CI 1.218-1.515; P < 0.001) and 10-year mortality (OR 1.534, 95% CI 1.290-1.825; P < 0.001) were increased in patients with PPM. Both severe PPM and moderate PPM were associated with increased risk of perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality when analysed together and separately, although we observed a higher risk in the group with severe PPM. CONCLUSIONS: Moderate/severe PPM increases perioperative, early-, mid- and long-term mortality rates proportionally to its severity. The findings of this study support the implementation of surgical strategies to prevent PPM in order to decrease mortality rates.

Prevalence of Obstructive Sleep Apnea and Obesity Among Middle-Aged Women: Implications for Exercise Capacity.

STUDY OBJECTIVES: The aim of the current study was to evaluate the association between obstructive sleep apnea (OSA) and exercise capacity in middle-aged women. METHODS: Consecutive middle-aged female subjects without cardiovascular disease, aged 45 to 65 years, from two gynecological clinics underwent detailed clinical evaluation, portable sleep study, and treadmill exercise test. RESULTS: We studied 232 women (age: 55.6 ± 5.2 years; body mass index [BMI]: 28.0 ± 4.8 kg/m2). OSA (apnea-hypopnea index ≥ 5 events/h) was diagnosed in 90 (39%) and obesity (BMI > 30 kg/m2) in 76 (33%) women, respectively. Participants with OSA were older, had a higher BMI, and an increased frequency of arterial hypertension compared to women without OSA. Multiple logistic regression models were used to evaluate the association between OSA and exercise capacity, controlling for traditional risk factors including BMI, age, hypertension, diabetes, and sedentary lifestyle. In multivariate analysis, the presence of obesity without OSA was associated with low exercise capacity (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.02-8.11, P = .045), whereas the presence of OSA without obesity was not (OR 1.07, 95% CI 0.31-3.69, P = .912). However, the coexistence of obesity and OSA increased markedly the odds of reduction in exercise capacity (OR 9.40, CI 3.79-23.3, P < .001). CONCLUSIONS: Obesity and OSA are common conditions in middle-aged women and may interact to reduce exercise capacity. These results highlight the importance of obesity control programs among women, as well as the diagnosis of comorbid OSA in older women.