Document Detail

Prosthesis - patient mismatch with latest generation supra-annular prostheses. The beginning of the end?
MedLine Citation:
PMID:  17669906     Owner:  NLM     Status:  MEDLINE    
Most studies about prosthesis-patient mismatch (PPM) were conducted before the introduction of new high-performance prostheses. Nowadays, PPM could become unfrequent. Our aim was to study the impact of new prostheses on PPM in comparison with previous experience. Prosthetic Indexed Effective Orifice Area (EOAi) was estimated in two historical cohorts. Group A: 339 patients undergoing AVR from Mar 94-Nov 01. Group B: 404 operated on during the last three years when latest generation prostheses were implanted. Incidence, determinants of PPM and clinical results were studied. Moderate PPM (EOAi <or=0.85 cm(2)/m(2)) was present in 38% and 19% (respective groups). Mean EOAi increased from 1.02+/-0.29 cm(2)/m(2) to 1.11+/-0.27 cm(2)/m(2). 'Group B' and 'new prostheses' were protective. Thirty-day mortality was 3.8% and 4.7% with higher rate in patients with increased left ventricular mass index (LVMI), especially if PPM was present: 14.7 vs. 2.1% (P<0.05) in Group A; 25.0 vs. 4.8% (P<0.05) in Group B (PPM vs. no-PPM). LVMI regression was impaired in these patients. Moderate PPM was an independent predictor of late cardiac mortality (OR: 3.38, 95% CI: 1.37-8.31; P<0.01). PPM is a prognostic factor for late cardiac death. Its impact on early mortality is only relevant in patients with high LVMI. Its incidence has decreased with the use of new prostheses.
Rafael García Fuster; Vanesa Estevez; Ignacio Rodríguez; Sergio Cánovas; Oscar Gil; Fernando Hornero; Juan Martínez-León
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Publication Detail:
Type:  Journal Article     Date:  2007-04-16
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  6     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-02     Completed Date:  2007-08-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  462-9     Citation Subset:  IM    
University General Hospital of Valencia, Valencia, Spain.
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MeSH Terms
Aortic Valve / surgery*
Heart Valve Prosthesis* / adverse effects
Heart Valve Prosthesis Implantation* / adverse effects,  mortality
Middle Aged
Prosthesis Design
Prosthesis Fitting*

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