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Prosthesis-patient mismatch in bovine pericardial aortic valves: evaluation using 3 different modalities and
Satish Jacob Chacko1, Asimul H Ansari, Patrick M McCarthy
1Northwestern University, Chicago, IL.
Background:
The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines-suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area-indexed, effective orifice area (EOAi PPM) measurement.
Methods And Results:
A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤ 0.60 cm(2)/m(2), moderate if EOAi was 0.60 to 0.85 cm(2)/m(2), and absent (none) if EOAi was ≥ 0.85 cm(2)/m(2). ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM (P=1.00). ASE PPM differed significantly from EOAi PPM (P<0.001), which identified severe mismatch in 170 (29.7%), moderate in 191 (33.4%), and absent (none) in 211 patients (36.9%). Irrespective of the PPM classification method, PPM did not adversely affect midterm survival (average follow-up, 4.1 ± 1.8 years; median, 3.9 years; range, 0.01-8 years). There were no reoperations for PPM.
Conclusions:
In patients with normal systolic function undergoing bovine pericardial aortic valve replacement, the prevalence of PPM using the algorithmic-ASE approach was low and correlated well with manufacturer-provided PPM. Independent of the method of PPM assessment, PPM was not associated with medium-term mortality.
Insights
Prosthesis-patient mismatch (PPM) after aortic valve replacement was assessed using three methods. Regardless of the method, PPM did not impact midterm survival in patients with normal systolic function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) has unclear prevalence and survival impact.
- Historical PPM assessment methods (echocardiography, manufacturer charts) showed discrepancies.
- The 2009 American Society of Echocardiography (ASE) guidelines introduced an algorithmic approach for PPM calculation.
Purpose of the Study:
- To compare PPM prevalence and its impact on survival using three distinct assessment modalities.
- To evaluate the consistency between ASE guidelines, manufacturer data, and echocardiographic measurements for PPM.
- To determine if PPM affects midterm survival after AVR.
Main Methods:
- A cohort of 614 patients undergoing AVR with bovine pericardial valves (2004-2009) and normal preoperative systolic function was analyzed.
- PPM was assessed using: (1) ASE guidelines algorithm (ASE PPM), (2) manufacturer-provided charts (M PPM), and (3) echocardiographically measured effective orifice area indexed to body surface area (EOAi PPM).
- Survival analysis was performed with an average follow-up of 4.1 years.
Main Results:
- ASE PPM prevalence was low (severe: 3.6%, moderate: 1%, none: 95.4%) and consistent with manufacturer-provided PPM (P=1.00).
- ASE PPM differed significantly from EOAi PPM (P<0.001), with EOAi PPM identifying severe mismatch in 29.7%, moderate in 33.4%, and none in 36.9% of patients.
- PPM, irrespective of the classification method, did not adversely affect midterm survival, and no reoperations for PPM occurred.
Conclusions:
- The ASE algorithmic approach for PPM in bovine pericardial AVR with normal systolic function showed low prevalence and good correlation with manufacturer data.
- PPM assessment method did not influence the finding that PPM is not associated with medium-term mortality.
- These findings suggest PPM may not be a significant factor for midterm survival in this specific patient population.
