Document Detail


Impact of valve prosthesis-patient mismatch on left ventricular mass regression following aortic valve replacement.
MedLine Citation:
PMID:  15680824     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Valve prosthesis-patient mismatch is a frequent problem in patients undergoing aortic valve replacement and its main hemodynamic consequence is to generate high transvalvular gradients through normally functioning prosthetic valves. The persistence of high gradients may hinder or delay the regression of left ventricular hypertrophy after aortic valve replacement. METHODS: The aim of the study was to determine the impact of prosthesis-patient mismatch on the postoperative regression of left ventricular mass. Left ventricular mass was measured by Doppler echocardiography in 109 patients undergoing aortic valve replacement with a single type of bioprosthesis (Carpentier-Edwards Perimount) for pure aortic stenosis. Prosthesis-patient mismatch was defined as a projected indexed effective orifice area less than 0.90 cm2/m2. On this basis, 58/109 (53.2%) patients had prosthesis-patient mismatch. RESULTS: There was a good correlation (r = 0.61, p < 0.001) between the postoperative mean transprosthetic gradient and the projected indexed effective orifice area. The absolute and relative left ventricular mass regression was significantly (p = 0.002 and p = 0.01, respectively) lower in patients with prosthesis-patient mismatch (-48 +/- 47 g, -17% +/- 16%) compared to those with no prosthesis-patient mismatch (-77 +/- 49 g, -24% +/- 14%). In multivariate analysis, a larger projected indexed effective orifice area, female gender and a higher preoperative left ventricular mass are independent predictors of greater left ventricular mass regression. CONCLUSIONS: This study shows that in patients with pure aortic stenosis prosthesis-patient mismatch is associated with lesser regression of left ventricular hypertrophy after aortic valve replacement. These findings may have important clinical implications given that prosthesis-patient mismatch is frequent in these patients.
Authors:
Giordano Tasca; Federico Brunelli; Marco Cirillo; Margherita DallaTomba; Zen Mhagna; Giovanni Troise; Eugenio Quaini
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  79     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-01-31     Completed Date:  2005-09-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  505-10     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy. cch-segreteria.poli@poliambulanza.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve / surgery
Aortic Valve Stenosis / surgery*
Bioprosthesis*
Echocardiography, Doppler
Female
Follow-Up Studies
Heart Valve Prosthesis / adverse effects*
Heart Ventricles / ultrasonography*
Humans
Hypertrophy, Left Ventricular / etiology*,  ultrasonography*
Male
Preoperative Care
Prosthesis Fitting

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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