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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Impact of prosthesis-patient mismatch on early haemodynamic status after aortic valve replacement
Michel Kindo1, Tam Hoang Minh2, Stéphanie Perrier2
1Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France michel.kindo@chru-strasbourg.fr.
Objectives:
Prosthesis-patient mismatch (PPM) has been reported to impact early haemodynamic status and early mortality after prosthetic aortic valve replacement (AVR) in patients with aortic stenosis (AS). The aim of this study was to assess the impact of PMM on early haemodynamic status after AVR using vasoactive-inotropic dependency index (VDI), postoperative pressures and end-organ perfusion.
Methods:
A total of 183 patients with AS were included in this prospective cohort study, and underwent elective AVR with or without combined coronary artery bypass graft surgery. PPM was defined as a projected indexed effective orifice area of ≤0.85 cm2/m2, and was present in 27.9% of the patients. The primary end-point was the VDI [VDI = vasoactive-inotropic score/mean arterial pressure] measured upon admission to the intensive care unit (POD0) and on the morning of the first postoperative day (POD1). The secondary end-points were the following: mean left atrial pressure, mean central venous pressure, fluid balance, brain natriuretic peptide, troponin I, glomerular filtration rate and lactate levels on POD0 and POD1.
Results:
No significant differences in VDI were observed between the no PPM and PPM groups on POD0 (0.08 ± 0.48 vs 0.05 ± 0.13, respectively, P = 0.622) or on POD1 (0.09 ± 0.40 vs 0.06 ± 0.13, respectively; P = 0.583). The mean arterial pressure, mean left atrial pressure, central venous pressure, troponin I, glomerular filtration rate and lactate levels did not differ between the two groups on POD0 and POD1, as well as fluid balance and brain natriuretic peptide on POD1.
Conclusions:
PPM is not associated with early haemodynamic status impairment and end-organ perfusion after AVR.
Clinical Trial Number:
ClinicalTrials.gov number, NCT00699673.
Insights
Prosthesis-patient mismatch (PPM) does not impact early hemodynamic status or end-organ perfusion after aortic valve replacement (AVR). This study found no significant differences in key hemodynamic markers between patients with and without PPM post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Hemodynamics
Background:
- Prosthesis-patient mismatch (PPM) is a potential concern after aortic valve replacement (AVR) for aortic stenosis (AS).
- Previous reports suggest PPM may affect early hemodynamic status and mortality.
- The impact of PPM on early postoperative recovery requires further investigation.
Purpose of the Study:
- To assess the effect of PPM on early hemodynamic status after AVR.
- To evaluate the influence of PPM on end-organ perfusion using specific clinical markers.
- To analyze vasoactive-inotropic dependency index (VDI) and other hemodynamic parameters in relation to PPM.
Main Methods:
- A prospective cohort study included 183 patients undergoing elective AVR for AS.
- PPM was defined as a projected indexed effective orifice area ≤0.85 cm²/m².
- Primary endpoint was VDI; secondary endpoints included pressures, fluid balance, BNP, troponin I, GFR, and lactate levels on POD0 and POD1.
Main Results:
- No significant differences in VDI were observed between patients with and without PPM on POD0 and POD1.
- Mean arterial pressure, left atrial pressure, and central venous pressure did not differ between groups.
- Secondary endpoints including fluid balance, BNP, troponin I, GFR, and lactate also showed no significant differences.
Conclusions:
- PPM is not associated with early hemodynamic status impairment after AVR.
- End-organ perfusion is not adversely affected by PPM in the early postoperative period.
- These findings suggest PPM may not be a critical factor for early recovery post-AVR.
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