Valvular heart diseaseInteraction and Prognostic Effects of Left Ventricular Diastolic Dysfunction and Patient-Prosthesis Mismatch as Determinants of Outcome After Isolated Aortic Valve Replacement
Section snippets
Methods
We studied 156 consecutive patients who had undergone AVR from 1998 to 2008 and undergone postoperative, clinically indicated follow-up echocardiography (Figure 1). Demographic variables and preoperative, operative, and postoperative clinical data were collected for each patient, including functional status, surgical risk, and prosthesis type and size. Clinical and investigation data were used to define surgical risk using the Euroscore.10
This study included patients who underwent AVR only, for
Results
Using the cutoff of ≤0.85 cm2/m2, we were able to identify 91 patients (58%) who had mismatch. Table 2 lists differences in demographic features between patients with and without P-PM, as well as a number of features that point to a small heart, including lower cardiac volumes and the use of bioprosthetic valves. However, there were no other differences in risk factors for outcomes, including cardiac function and surgical risk. P-PM occurred in 78 of the 115 patients (68%) who underwent AVR for
Discussion
The results of this study of outcomes in patients having postoperative echocardiograms was that P-PM was not predictive of death or total events over an intermediate follow-up period of 3 years. However, persisting DD was associated with P-PM, and events were significantly associated with the presence of DD, independent of P-PM. Survival was particularly decreased in patients with more severe classes of DD.
DD is almost universal in patients with aortic stenosis but usually improves with the
References (28)
- et al.
Impact of the improvement of valve area achieved with aortic valve replacement on the regression of left ventricular hypertrophy in patients with pure aortic stenosis
Ann Thorac Surg
(2005) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005) - et al.
Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons
Mayo Clin Proc
(1994) - et al.
Association of arterial wave properties and diastolic dysfunction in patients with type 2 diabetes mellitus
Am J Cardiol
(2007) - et al.
Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosis
J Thorac Cardiovasc Surg
(1999) - et al.
Left ventricular diastolic dysfunction late after aortic valve replacement in patients with aortic stenosis
Am J Cardiol
(2005) - et al.
Preoperative moderate to severe diastolic dysfunction: a novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosis
J Thorac Cardiovasc Surg
(2005) - et al.
Influence of prosthesis-patient mismatch on diastolic heart failure after aortic valve replacement
Ann Thorac Surg
(2008) - et al.
Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention
J Am Coll Cardiol
(2000) - et al.
Late incidence and predictors of persistent or recurrent heart failure in patients with aortic prosthetic valves
J Thorac Cardiovasc Surg
(2004)
Prosthesis-patient mismatch is associated with higher operative mortality following aortic valve replacement
Heart Lung Circ
Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant
Ann Thorac Surg
Prosthesis size and long-term survival after aortic valve replacement
J Thor Cardiovasc Surg
Aortic valve replacement with patch enlargement of the aortic annulus
Ann Thorac Surg
Cited by (11)
Valve Disease
2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection FractionProsthesisPatient mismatch in the transcatheter aortic valve replacement Era
2011, Journal of the American College of CardiologyPre- and Post-operative diastolic dysfunction in patients with valvular heart disease: Diagnosis and therapeutic implications
2013, Journal of the American College of CardiologyCitation Excerpt :Patient-prosthesis mismatch can contribute to persistent diastolic dysfunction due to elevated LV systolic pressure and limited regression of LV hypertrophy. It appears that diastolic dysfunction is one of the major mechanisms by which mismatch contributes to clinical events of death and hospitalizations in this setting (19). The diagnostic evaluation of these patients is geared toward identifying and grading the diastolic dysfunction as well as determining the potential underlying reasons.
Impact of aortic valve replacement for aortic stenosis on coexisting mitral stenosis
2021, Annals of Thoracic and Cardiovascular SurgeryCalcific aortic stenosis: A peculiar feature of diastolic heart failure in the elderly
2017, Journal of Gerontology and GeriatricsAortic stenosis
2015, Learning Cardiac Auscultation: From Essentials to Expert Clinical Interpretation
This study was supported in part by a program grant from the National Health and Medical Research Council, Canberra, Australia.