Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?
a Department of Cardiac Surgery, Clinica Capio, Albacete, Spain b Department of Cardiac Surgery, Policlinica Gipuzkoa, San Sebastian, Spain *Corresponding author. Tel.: +34 9672427100; fax: +34 967245183. E-mail address : stefano_urso{at}inwind.it (S. Urso). A best evidence topic in cardiac surgery...
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| Veröffentlicht in: | Interactive cardiovascular and thoracic surgery 2009-09, Vol.9 (3), p.510-518 |
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| creator | Urso, Stefano Sadaba, Rafael Aldamiz-Echevarria, Gonzalo |
| description | a Department of Cardiac Surgery, Clinica Capio, Albacete, Spain
b Department of Cardiac Surgery, Policlinica Gipuzkoa, San Sebastian, Spain
*Corresponding author. Tel.: +34 9672427100; fax: +34 967245183. E-mail address : stefano_urso{at}inwind.it (S. Urso).
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is patient-prosthesis mismatch an independent risk factor for 30-day and mid-term overall mortality in adult patients undergoing aortic valve replacement (AVR)? Altogether, almost 400 papers were found using the reported search, of which 22 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The majority of the selected articles have focused their analysis on moderate mismatch defined mostly by the presence of an indexed effective orifice area (IEOA) 0.85 cm 2 /m 2 . In fact, because of the low incidence of patients with severe mismatch, these were often grouped for the statistical analysis with patients with moderate mismatch. Only six studies have analyzed the specific condition of severe mismatch (IEOA0.65 cm 2 /m 2 ) is an independent risk factor for 30-day or mid-term overall mortality for adult patients undergoing AVR. An exception could be represented by patients with poor ejection fraction, a condition that can make moderate mismatch a predictor of overall mortality after AVR. On the other hand, severe mismatch is a predictor of overall 30-day or mid-term mortality for patients undergoing AVR independently from the presence of poor ejection fraction. In conclusion, our review suggests that the condition of severe PPM should be always avoided, while the presence of moderate mismatch could be tolerated in patients with normal ejection fraction without any impact on overall survival.
Key Words: Aortic valve; Heart valve prosthesis; Mortality
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| doi_str_mv | 10.1510/icvts.2009.207597 |
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b Department of Cardiac Surgery, Policlinica Gipuzkoa, San Sebastian, Spain
*Corresponding author. Tel.: +34 9672427100; fax: +34 967245183. E-mail address : stefano_urso{at}inwind.it (S. Urso).
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is patient-prosthesis mismatch an independent risk factor for 30-day and mid-term overall mortality in adult patients undergoing aortic valve replacement (AVR)? Altogether, almost 400 papers were found using the reported search, of which 22 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The majority of the selected articles have focused their analysis on moderate mismatch defined mostly by the presence of an indexed effective orifice area (IEOA) 0.85 cm 2 /m 2 . In fact, because of the low incidence of patients with severe mismatch, these were often grouped for the statistical analysis with patients with moderate mismatch. Only six studies have analyzed the specific condition of severe mismatch (IEOA<0.65 cm 2 /m 2 ). Three studies used the IEOA or indexed geometric orifice area (IGOA) as a continuous variable. We conclude that there is no strong evidence that moderate patient-prosthesis mismatch (PPM) (indexed IEOA 0.85 and >0.65 cm 2 /m 2 ) is an independent risk factor for 30-day or mid-term overall mortality for adult patients undergoing AVR. An exception could be represented by patients with poor ejection fraction, a condition that can make moderate mismatch a predictor of overall mortality after AVR. On the other hand, severe mismatch is a predictor of overall 30-day or mid-term mortality for patients undergoing AVR independently from the presence of poor ejection fraction. In conclusion, our review suggests that the condition of severe PPM should be always avoided, while the presence of moderate mismatch could be tolerated in patients with normal ejection fraction without any impact on overall survival.
Key Words: Aortic valve; Heart valve prosthesis; Mortality
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Leo A. Bockeria, Ivan I. Skopin, Irma M. Tsiskaridze, and Darya V. Murysova
Interactive CardioVascular and Thoracic Surgery 2009 9: 518-519.
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[PDF]</description><identifier>ISSN: 1569-9293</identifier><identifier>EISSN: 1569-9285</identifier><identifier>DOI: 10.1510/icvts.2009.207597</identifier><identifier>PMID: 19497953</identifier><language>eng</language><publisher>England: Eur Assoc Cardio Surg</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve - pathology ; Aortic Valve - physiopathology ; Aortic Valve - surgery ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - pathology ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Benchmarking ; Evidence-Based Medicine ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - instrumentation ; Heart Valve Prosthesis Implantation - mortality ; Hemodynamics ; Humans ; Male ; Middle Aged ; Patient Selection ; Prosthesis Design ; Risk Assessment ; Risk Factors ; Stroke Volume ; Time Factors ; Treatment Outcome</subject><ispartof>Interactive cardiovascular and thoracic surgery, 2009-09, Vol.9 (3), p.510-518</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2887-3f7ce84e658e0f87031d315d65f3d929baefc766d83f109957b23985ec2390863</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19497953$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Urso, Stefano</creatorcontrib><creatorcontrib>Sadaba, Rafael</creatorcontrib><creatorcontrib>Aldamiz-Echevarria, Gonzalo</creatorcontrib><title>Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?</title><title>Interactive cardiovascular and thoracic surgery</title><addtitle>Interact Cardiovasc Thorac Surg</addtitle><description>a Department of Cardiac Surgery, Clinica Capio, Albacete, Spain
b Department of Cardiac Surgery, Policlinica Gipuzkoa, San Sebastian, Spain
*Corresponding author. Tel.: +34 9672427100; fax: +34 967245183. E-mail address : stefano_urso{at}inwind.it (S. Urso).
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is patient-prosthesis mismatch an independent risk factor for 30-day and mid-term overall mortality in adult patients undergoing aortic valve replacement (AVR)? Altogether, almost 400 papers were found using the reported search, of which 22 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The majority of the selected articles have focused their analysis on moderate mismatch defined mostly by the presence of an indexed effective orifice area (IEOA) 0.85 cm 2 /m 2 . In fact, because of the low incidence of patients with severe mismatch, these were often grouped for the statistical analysis with patients with moderate mismatch. Only six studies have analyzed the specific condition of severe mismatch (IEOA<0.65 cm 2 /m 2 ). Three studies used the IEOA or indexed geometric orifice area (IGOA) as a continuous variable. We conclude that there is no strong evidence that moderate patient-prosthesis mismatch (PPM) (indexed IEOA 0.85 and >0.65 cm 2 /m 2 ) is an independent risk factor for 30-day or mid-term overall mortality for adult patients undergoing AVR. An exception could be represented by patients with poor ejection fraction, a condition that can make moderate mismatch a predictor of overall mortality after AVR. On the other hand, severe mismatch is a predictor of overall 30-day or mid-term mortality for patients undergoing AVR independently from the presence of poor ejection fraction. In conclusion, our review suggests that the condition of severe PPM should be always avoided, while the presence of moderate mismatch could be tolerated in patients with normal ejection fraction without any impact on overall survival.
Key Words: Aortic valve; Heart valve prosthesis; Mortality
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eComment: Prosthesis-patient mismatch: a need to individualize the preventive strategy according to the baseline characteristics of the patient
Philippe Pibarot
Interactive CardioVascular and Thoracic Surgery 2009 9: 518.
[Full Text]
[PDF]
eComment: Independent risk factors of in-hospital mortality in patients undergoing aortic valve replacement
Leo A. Bockeria, Ivan I. Skopin, Irma M. Tsiskaridze, and Darya V. Murysova
Interactive CardioVascular and Thoracic Surgery 2009 9: 518-519.
[Full Text]
[PDF]</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - pathology</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - pathology</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Benchmarking</subject><subject>Evidence-Based Medicine</subject><subject>Female</subject><subject>Heart Valve Prosthesis</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Heart Valve Prosthesis Implantation - instrumentation</subject><subject>Heart Valve Prosthesis Implantation - mortality</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Selection</subject><subject>Prosthesis Design</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stroke Volume</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1569-9293</issn><issn>1569-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkc2OVCEQhYnROOPoA7gxrNzdES7NBVbGTEadZBI3uiY0FN0o90fgtulH8W2tsVtnQRWLr07l1CHkNWfXXHL2LvlDq9c9YwaLkkY9IZdcDqYzvZZP__-NuCAvav3OGDdMsOfkgpuNUUaKS_L7rtLFtQRT65Yy17aHmiodUx1d83vqJpqmAAtgmRotqf6g0fk2FxrxgSv5iFDAidA1KCOdD1BcznScS3M5tSMKUBfW3P4tqnRFtbKb07SjDrHk6cHlA9ACS3YeRoTevyTPossVXp37Ffn28fbrzefu_sunu5sP953vtVadiMqD3sAgNbCoFRM8CC7DIKMI6H3rIHo1DEGLyJkxUm17YbQEj43pQVyRtyddtP9zhdosmveQs5tgXqsdlNRKyw2C_AR6vFMtEO1S0ujK0XJmH_Kwf_OwD3nYUx448-Ysvm5HCI8T5wAet-_Tbv8rFbB4-JwR709yxgqL2uIPmneY1Q</recordid><startdate>20090901</startdate><enddate>20090901</enddate><creator>Urso, Stefano</creator><creator>Sadaba, Rafael</creator><creator>Aldamiz-Echevarria, Gonzalo</creator><general>Eur Assoc Cardio Surg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090901</creationdate><title>Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?</title><author>Urso, Stefano ; Sadaba, Rafael ; Aldamiz-Echevarria, Gonzalo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2887-3f7ce84e658e0f87031d315d65f3d929baefc766d83f109957b23985ec2390863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - pathology</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - pathology</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Benchmarking</topic><topic>Evidence-Based Medicine</topic><topic>Female</topic><topic>Heart Valve Prosthesis</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Heart Valve Prosthesis Implantation - instrumentation</topic><topic>Heart Valve Prosthesis Implantation - mortality</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Selection</topic><topic>Prosthesis Design</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stroke Volume</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Urso, Stefano</creatorcontrib><creatorcontrib>Sadaba, Rafael</creatorcontrib><creatorcontrib>Aldamiz-Echevarria, Gonzalo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Interactive cardiovascular and thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Urso, Stefano</au><au>Sadaba, Rafael</au><au>Aldamiz-Echevarria, Gonzalo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?</atitle><jtitle>Interactive cardiovascular and thoracic surgery</jtitle><addtitle>Interact Cardiovasc Thorac Surg</addtitle><date>2009-09-01</date><risdate>2009</risdate><volume>9</volume><issue>3</issue><spage>510</spage><epage>518</epage><pages>510-518</pages><issn>1569-9293</issn><eissn>1569-9285</eissn><abstract>a Department of Cardiac Surgery, Clinica Capio, Albacete, Spain
b Department of Cardiac Surgery, Policlinica Gipuzkoa, San Sebastian, Spain
*Corresponding author. Tel.: +34 9672427100; fax: +34 967245183. E-mail address : stefano_urso{at}inwind.it (S. Urso).
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is patient-prosthesis mismatch an independent risk factor for 30-day and mid-term overall mortality in adult patients undergoing aortic valve replacement (AVR)? Altogether, almost 400 papers were found using the reported search, of which 22 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The majority of the selected articles have focused their analysis on moderate mismatch defined mostly by the presence of an indexed effective orifice area (IEOA) 0.85 cm 2 /m 2 . In fact, because of the low incidence of patients with severe mismatch, these were often grouped for the statistical analysis with patients with moderate mismatch. Only six studies have analyzed the specific condition of severe mismatch (IEOA<0.65 cm 2 /m 2 ). Three studies used the IEOA or indexed geometric orifice area (IGOA) as a continuous variable. We conclude that there is no strong evidence that moderate patient-prosthesis mismatch (PPM) (indexed IEOA 0.85 and >0.65 cm 2 /m 2 ) is an independent risk factor for 30-day or mid-term overall mortality for adult patients undergoing AVR. An exception could be represented by patients with poor ejection fraction, a condition that can make moderate mismatch a predictor of overall mortality after AVR. On the other hand, severe mismatch is a predictor of overall 30-day or mid-term mortality for patients undergoing AVR independently from the presence of poor ejection fraction. In conclusion, our review suggests that the condition of severe PPM should be always avoided, while the presence of moderate mismatch could be tolerated in patients with normal ejection fraction without any impact on overall survival.
Key Words: Aortic valve; Heart valve prosthesis; Mortality
Related Articles
eComment: Prosthesis-patient mismatch: a need to individualize the preventive strategy according to the baseline characteristics of the patient
Philippe Pibarot
Interactive CardioVascular and Thoracic Surgery 2009 9: 518.
[Full Text]
[PDF]
eComment: Independent risk factors of in-hospital mortality in patients undergoing aortic valve replacement
Leo A. Bockeria, Ivan I. Skopin, Irma M. Tsiskaridze, and Darya V. Murysova
Interactive CardioVascular and Thoracic Surgery 2009 9: 518-519.
[Full Text]
[PDF]</abstract><cop>England</cop><pub>Eur Assoc Cardio Surg</pub><pmid>19497953</pmid><doi>10.1510/icvts.2009.207597</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford Journals Open Access Collection; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Aged, 80 and over Aortic Valve - pathology Aortic Valve - physiopathology Aortic Valve - surgery Aortic Valve Stenosis - mortality Aortic Valve Stenosis - pathology Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Benchmarking Evidence-Based Medicine Female Heart Valve Prosthesis Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - instrumentation Heart Valve Prosthesis Implantation - mortality Hemodynamics Humans Male Middle Aged Patient Selection Prosthesis Design Risk Assessment Risk Factors Stroke Volume Time Factors Treatment Outcome |
| title | Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement? |
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