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Aortic valve replacement: is valve size important?
B Medalion1, E H Blackstone, B W Lytle
1Department of Thoracic and Cardiovascular Surgery and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Summary
Aortic valve replacement survival is linked to patient risk factors, not prosthesis size. Moderate patient-prosthesis mismatch does not adversely affect outcomes after aortic valve replacement.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Outcomes Research
Background:
- Aortic valve replacement (AVR) is a common procedure for aortic stenosis.
- Prosthesis-patient mismatch (PPM) is a potential concern after AVR.
- The impact of PPM on long-term survival requires further investigation.
Purpose of the Study:
- To determine if aortic prosthesis size negatively impacts survival after aortic valve replacement.
- To analyze the relationship between indexed valve area and patient survival.
- To assess the influence of patient risk factors on survival post-AVR.
Main Methods:
- A cohort of 892 adults undergoing primary isolated AVR for aortic stenosis was studied.
- Patients received mechanical, pericardial, or allograft valves.
- Multivariable propensity scores and hazard function analyses were used to adjust for confounders and identify mortality risk factors.
Main Results:
- Twenty-five percent of patients exhibited indexed internal orifice areas more than 2 standard deviations below predicted normal size.
- Mechanical valves had smaller orifices compared to pericardial or allograft valves.
- Survival was not adversely affected by moderate patient-prosthesis mismatch (down to approximately 4 SDs below normal).
Conclusions:
- Survival after aortic valve replacement is primarily influenced by patient-specific risk factors.
- Moderate degrees of patient-prosthesis mismatch do not appear to compromise survival.
- Aortic root enlargement may be necessary in select cases to implant larger prostheses.