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Benchmarking Outcomes: Reoperation for Aortic Valve Patient-Prosthesis Mismatch
William B Keeling1, Ziv Beckerman2, Jane Wei3
1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
The Annals of Thoracic Surgery
|September 27, 2020
Summary
Reoperative aortic valve replacement for patient-prosthesis mismatch (PPM) is complex but feasible. Experienced centers can achieve good outcomes and low mortality, offering valuable data for current treatment strategies.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Surgery
- Aortic Valve Replacement
Background:
- Surgical reoperations for symptomatic aortic valve patient-prosthesis mismatch (PPM) present significant complexity.
- Prior aortic valve replacement can lead to symptomatic PPM, necessitating further intervention.
Purpose of the Study:
- To investigate the clinical and echocardiographic outcomes of patients undergoing reoperation for symptomatic PPM.
- To evaluate the safety and efficacy of reoperative aortic valve surgery for PPM.
Main Methods:
- A review of 60 patients undergoing reoperative aortic valve replacement for PPM between 2004 and 2018.
- Univariate analyses were performed to identify risk factors for perioperative mortality.
Main Results:
- The study included patients with a median age of 62.8 years; 66% had their first reoperation.
- Significant improvements in mean pressure gradients (32.1 to 6.6 mm Hg) and aortic valve area (0.8 to 2.3 cm2) were observed post-reoperation (P < .001).
- Operative mortality was 5.0%, with stroke and renal failure rates at 3.3% and 5.0%, respectively.
Conclusions:
- Reoperative surgery for PPM, while complex, can be performed with favorable outcomes and low mortality at experienced centers.
- The findings establish important clinical and hemodynamic benchmarks for PPM management, especially in the context of evolving valve-in-valve transcatheter aortic valve replacement.
