Document Detail

Reconsideration of patient-prosthesis mismatch definition from the valve indexed effective orifice area.
MedLine Citation:
PMID:  20494055     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The objective of this study was to reassess the validity of defining patient-prosthesis mismatch (PPM) in the aortic position on the basis of an indexed effective orifice area (iEOA) less than 0.85 cm(2)/m(2). METHODS: From June 1996 to March 2008, 342 patients underwent aortic valve replacement with a Carpentier-Edwards Perimount valve. From the data collected, the transvalvular pressure gradient was determined by the modified Bernoulli equation, and EOA was calculated from the standard continuity equation. RESULTS: The actuarial survival rate at 10 years after surgery was 84.0% +/- 8.2%. The prevalence of PPM was 6.1% when a projected iEOA less than 0.85 cm(2)/m(2) was defined as indicating significant PPM. There was no difference between patients with moderate PPM (85.2% +/- 9.8%) and patients without PPM (81.0% +/- 8.7%; p = 0.44). The relation between mean transvalvular pressure gradient and iEOA demonstrated a gentler slope than that reported previously. Postoperative mean transvalvular pressure gradient was 17.4 +/- 5.6 mm Hg and 14.5 +/- 5.6 mm Hg in patients with an iEOA less than 0.85 and 0.85 or greater, respectively. Most patients had a postoperative mean transvalvular pressure gradient more than 10 mm Hg regardless of PPM. CONCLUSIONS: Our analysis suggested that an iEOA less than 2.0 cm(2)/m(2) might be the threshold for PPM, which should not be passed to achieve a low mean transvalvular pressure gradient (less than 10 mm Hg) with the Carpentier-Edwards Perimount valve. The implications of these findings include the necessity for reassessing the hemodynamic performance of each type of prosthesis when attempting to define PPM, to avoid residual significant transvalvular pressure gradient.
Yoshimasa Sakamoto; Michio Yoshitake; Hirokuni Naganuma; Noriyasu Kawada; Katsushi Kinouchi; Kazuhiro Hashimoto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-24     Completed Date:  2010-06-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1951-5     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Cardiac Surgery, Jikei University School of Medicine, Tokyo, Japan.
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MeSH Terms
Aortic Valve / anatomy & histology*,  physiology,  surgery*
Heart Valve Prosthesis*
Organ Size
Patient Selection
Prosthesis Design
Retrospective Studies

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