Factors determining patient-prosthesis mismatch after aortic valve replacement--a prospective cohort study.
PLoS One
; 8(12): e81940, 2013.
Article
em En
| MEDLINE
| ID: mdl-24312608
ABSTRACT
OBJECTIVE:
"Patient-prosthesis mismatch" (PPM) after aortic valve replacement (AVR) has been reported to increase morbidity and mortality. Although algorithms have been developed to avoid PPM, factors favouring its occurrence have not been well defined. DESIGN ANDSETTING:
This was a prospective cohort study performed at the Medical University of Vienna. PATIENTS 361 consecutive patients who underwent aortic valve replacement for isolated severe aortic stenosis were enrolled. MAIN OUTCOMEMEASURES:
Patient- as well as prosthesis-related factors determining the occurrence of moderate and severe PPM (defined as effective orifice area indexed to body surface area ≤ 0.8 cm(2)/m(2)) were studied.RESULTS:
Postoperatively, 172 patients (48%) were diagnosed with PPM. The fact that predominantly female patients were affected (58% with PPM diagnosis in women versus 36% in men, p<0.001) was explained by the finding that they had smaller aortic root diameters (30.5±4.7 mm versus 35.3±4.2 mm, p<0.0001) and a higher proportion of bioprosthetic valves (82% versus 62%, p<0.0001), both independent predictors of PPM (aortic root diameter OR 0.009 [95% CI, 0.004;0.013]; pâ=â0.0003, presence of bioprosthetic valve OR 0.126 [95% CI, 0.078;0.175]; p<0.0001).CONCLUSIONS:
The occurrence of PPM is determined by aortic root diameter and prosthesis type. Novel sutureless bioprostheses with optimized hemodynamic performance or transcatheter aortic valves may become a promising alternative to conventional bioprosthetic valves in the future.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Falha de Prótese
/
Próteses Valvulares Cardíacas
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article