Incidence And Clinical Impact Of Patient-Prosthesis Mismatch After Rapid-Deployment Aortic Valve Replacement
Giorgia Cibin, Augusto D'Onofrio, Valentina Lombardi, Emma Bergonzoni, Chiara Tessari, Gino Gerosa
University of Padova, Padova, Italy.
OBJECTIVE: Aim of this study was to evaluate incidence and clinical impact of patient-prosthesis mismatch (PPM) after RDB implantation.
METHODS: We analysed data of all patients who underwent aortic valve replacement (AVR) for severe aortic valve stenosis with RDB. Preoperative variables were defined according to EuroSCORE criteria and postoperative complications according to VARC-2 definitions. PPM was defined as moderate and severe when effective aortic valve area index (EOAi) was between 0.85 cm2/m2and 0.65 cm2/m2 and <0.65 cm2/m2, respectively. Clinical and echocardiographic evaluation was performed preoperatively, at discharge and on a yearly basis thereafter.
RESULTS: Data of 205 consecutive patients undergoing RDB implantation were analyzed. Of these, 200 (97.6%) were discharged with a RBD (in 5 patients RDB was replaced intraoperatively with a stented bioprosthesis due to significant regurgitation) and represent the population of this study. At discharge, PPM was found in 13 patients (6.5%): moderate in 11 (5.5%) and severe in 2 (1%). Valve size distribution, incidence of PPM and hemodynamic data for each valve size are shown in Figure 1. At 30 days, mortality (0% vs. 0.5%, p=ns), myocardial infarction (0% vs. 0.5%, p=ns), stroke (0% vs. 1%, p=ns), and pacemaker implantation (7.7% vs. 7.5%, p=ns) were similar between patients with and without PPM. Median follow-up was 379 days (IQR: 20-772). Late mortality occurred in 4 patients (2%) and none had PPM at discharge. Re-hospitalization for heart failure occurred in 5 patients (2.5%)two of them with PPM (one moderate and one severe).
CONCLUSIONS: According to our data the incidence of PPM after RDB implantation is remarkably low, being moderate in 5,5% and severe in 1,1 %. Although its low incidence, PPM seems to have a significant clinical impact since 40% of these patients were re-hospitalized for heart failure.
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