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Published on: May 21, 2017
Patient-prosthesis mismatch and surgical aortic valve replacement outcomes: Retrospective analysis of single-center
Aurinjoy Gupta1, Hashem Aliter2, Chris Theriault3
1Northern Ontario School of Medicine, Ontario, Thunder Bay, Canada.
Background:
Patient-prosthesis mismatch (PPM) has been identified as a risk factor for mortality and reoperation in patients undergoing surgical aortic valve replacement (SAVR). We present a retrospective analysis of risk factors for PPM and the effects of PPM on early postoperative outcomes after SAVR.
Methods:
Chart review was conducted for patients (N = 3003) undergoing SAVR. PPM was calculated from valve reference orifice areas and patient body surface area. Logistic regression was used to analyze risk factors for PPM and develop a risk score from these results. Regression was also conducted to identify associations between projected PPM status and postoperative outcomes.
Results:
Risk factors for PPM included female sex, higher body mass index (BMI), and use of the St. Jude Epic valve. Patients receiving St. Jude trifecta valves or mechanical valves were less likely to have predicted PPM. We developed a risk score using BMI, sex, and valve type, and retrospectively predicted PPM in our cohort. Mild PPM (odds ratio [OR] = 2.267), severe PPM (OR = 2.869), male sex (OR = 2.091), and younger age (OR = 0.940) were all predictors of SAVR reoperation, while aortic root replacement was associated with reduced reoperation rates (OR = 0.122). Severe PPM carried a risk of in-hospital mortality (OR = 3.599), and moderate PPM carried a smaller but significant risk (OR = 1.920). Other factors increasing postoperative morbidity and mortality included older age, renal failure, and diabetes.
Conclusion:
PPM could be retrospectively predicted in our cohort using a risk calculation from sex, BMI and valve type. We conclude that all degrees of PPM carry risk for mortality and reoperation.
Insights
Patient-prosthesis mismatch (PPM) after surgical aortic valve replacement (SAVR) increases mortality and reoperation risk. A risk score using BMI, sex, and valve type can predict PPM, highlighting the importance of considering mismatch in SAVR outcomes.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Prosthetic Valve Design
Background:
- Patient-prosthesis mismatch (PPM) is a known risk factor for mortality and reoperation after surgical aortic valve replacement (SAVR).
- Understanding the predictors of PPM and its impact on early outcomes is crucial for optimizing patient care.
Purpose of the Study:
- To identify risk factors for developing PPM in patients undergoing SAVR.
- To assess the impact of PPM on early postoperative outcomes, including mortality and reoperation rates.
Main Methods:
- Retrospective analysis of 3003 patients undergoing SAVR.
- Calculation of PPM using valve orifice area and patient body surface area.
- Logistic regression to identify PPM risk factors and develop a predictive risk score.
- Association analysis between predicted PPM status and postoperative outcomes.
Main Results:
- Risk factors for PPM included female sex, higher BMI, and specific valve types (St. Jude Epic).
- St. Jude trifecta and mechanical valves were associated with lower PPM risk.
- A predictive risk score was developed using BMI, sex, and valve type.
- Mild and severe PPM significantly increased the risk of reoperation (OR=2.267, OR=2.869).
- Severe PPM increased in-hospital mortality risk (OR=3.599), with moderate PPM also showing a significant risk (OR=1.920).
Conclusions:
- Patient-prosthesis mismatch (PPM) can be predicted retrospectively using a risk score based on sex, BMI, and valve type.
- All degrees of PPM are associated with increased risks of mortality and reoperation following SAVR.
