Background
Methods
Study design
Patients
Surgical technique
Variable | Value |
---|---|
Prosthetic valve diameter (mm) | |
Median | 23 mm |
Prosthetic valve type | |
Mechanical | 1476 (49.9) |
St. Jude Medical Standard | 899 (30.4) |
ATS | 442 (14.9) |
St. Jude Medical Regent | 93 (3.1) |
St. Jude Medical HP | 42 (1.4) |
Biological (stented) | 1487 (50.1) |
Carpentier-Edwards Magna | 146 (4.9) |
Carpentier-Edwards Perimount | 611 (20.7) |
Sorin Mitroflow | 325 (11.0) |
Medtronic Mosaic | 134 (4.5.) |
St. Jude Medical Epic | 176 (6.0) |
Prosthesis-patient mismatch (PPM)
Statistics
Results
Characteristics of the patient population
Variable | No PPM | PPM |
P
| |
---|---|---|---|---|
(EOAI > 0.85 cm2/m2) n= 2613 | (EOAI ≤0.85 cm2/m2) n = 344 | |||
Age, years | 68±11 | 68±11 | 0.557 | |
Sex | ||||
Female | 965 (36.9) | 163 (47.4) | <0.001 | |
Endocarditis | 120 (4.6) | 15 (4.4) | 0.846 | |
Preoperative LV function | ||||
Severely impaired | (EF <30%) | 92 (3.5) | 11 (3.2) | 0.759 |
Hypertension | 1125 (43.1) | 166 (48.3) | 0.067 | |
Diabetes Mellitus | 413 (15.8) | 96 (27.9) | <0.001 | |
Body weight, kg | 77±13 | 84±15 | <0.001 | |
Height, cm | 170±9 | 170±9 | 0.807 | |
Body surface area (BSA), m2
| 1.89±0.19 | 1.95±0.18 | <0.001 | |
Body mass index (BMI), kg/m2
| 26.8±4.0 | 29.3±5.0 | <0.001 | |
Peripheral vascular disease (PVD) | 261 (10.0) | 41 (11.9) | 0.266 | |
Renal dysfunction | 147 (5.6) | 19 (5.5) | 0.938 | |
Chronic obstructive pulmonary disease (COPD) | 462 (17.7) | 72 (20.9) | 0.141 | |
Cerebrovascular accident (CVA) | 122 (4.7) | 236 (6.7) | 0.103 | |
Prosthetic valve diameter, mm | ||||
Median | 23 | 23 | ||
Prosthetic valve type | ||||
Mechanical | 1236 (47.3) | 240 (69.8) | <0.001 | |
Concomitant coronary artery bypass grafting (CABG) | 1121 (42.9) | 135 (39.2) | 0.197 | |
Cardiopulmonary bypass (CPB) time, min | 93±37 | 99±43 | 0.022 | |
Aortic cross-clamp time, min | 68±26 | 71±30 | 0.077 | |
Effective orifice area (EOA), cm2
| 2.14±0.44 | 1.54±0.17 | <0.001 | |
Indexed effective orifice area (EOAI), cm2/m2
| 1.14±0.21 | 0.79±0.06 | <0.001 | |
Additive EuroSCORE | 6±3 | 6±3 | 0.095 | |
Logistic EuroSCORE | 7.66± 8.14 | 8.64±9.29 | 0.146 | |
Previous cardiac surgery | 226 (8.6) | 59 (17.2) | <0.001 | |
Mean follow-up, years | 5.6±3.7 | 6.3±4.0 | <0.001 | |
Mortality ≤30 days | 100 (3.8) | 23 (6.7) | 0.013 |
Early mortality
Predictors of early mortality
Variable | Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|---|
P
| OR (95% CI) |
P
| OR (95% CI) | ||
Age, y | <0.001 | 1.04 (1.02-1.06) | <0.001 | 1.04 (1.02-1.07) | |
Sex (female) | 0.058 | 1.42 (0.99-2.04) | |||
Severely impaired LV function | (EF <30%) | 0.006 | 2.61 (1.32-5.14) | 0.026 | 2.24 (1.10-4.56) |
Hypertension | 0.669 | 1.08 (0.75-1.56) | |||
Diabetes Mellitus | 0.351 | 1.24 (0.79-1.94) | |||
Endocarditis | 0.006 | 2.38 (1.28-4.44) | 0.006 | 2.85 (1.36-5.96) | |
Body mass index (BMI), kg/m2
| 0.165 | 0.97 (0.93-1.01) | |||
Peripheral vascular disease (PVD) | 0.052 | 1.65 (0.99-2.73) | |||
Renal dysfunction | <0.001 | 2.68 (1.54-4.64) | 0.032 | 1.90 (1.06-3.40) | |
Chronic obstructive pulmonary disease (COPD) | 0.005 | 1.78 (1.19-2.68) | 0.029 | 1.61 (1.05-2.46) | |
Cerebrovascular accident (CVA) | 0.013 | 2.20 (1.18-4.08) | 0.110 | 1.71 (0.89-3.29) | |
Mechanical prosthetic valve | 0.418 | 0.86 (0.60-1.24) | |||
Concomitant coronary artery bypass grafting (CABG) | 0.004 | 1.71 (1.19-2.46) | 0.872 | 0.96 (0.62-1.51) | |
Cardiopulmonary bypass (CPB) time, min | <0.001 | 1.02 (1.01-1.02) | <0.001 | 1.01 (1.01-1.02) | |
Aortic cross-clamp time, min | <0.001 | 1.02 (1.01-1.02) | 0.691 | 1.00 (0.99-1.01) | |
Prosthesis-patient mismatch (PPM) (cut-off ≤ 0.85 cm2/m2) | 0.014 | 1.80 (1.13-2.88) | 0.120 | 1.50 (0.90-2.48) | |
Previous cardiac surgery | <0.001 | 2.96 (1.90-4.59) | 0.072 | 1.62 (0.96-2.75) |
Late mortality
Predictors of late mortality
Variable | Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|---|
P
| HR (95% CI) |
P
| HR (95% CI) | ||
Age, years | <0.001 | 1.07 (1.06-1.08) | <0.001 | 1.84 (1.33-2.56) | |
Sex (female) | 0.403 | 1.07 (0.91-1.26) | |||
Severely impaired LV function | (EF <30%) | <0.001 | 1.93 (1.40-2.67) | <0.001 | 2.24 (1.10-4.56) |
Hypertension | 0.055 | 1.17 (0.99-1.37) | |||
Diabetes Mellitus | <0.001 | 1.80 (1.49-2.17) | 0.001 | 1.41 (1.16-1.71) | |
Endocarditis | 0.118 | 0.70 (0.45-1.09) | |||
Body mass index (BMI), kg/m2
| 0.837 | 1.00 (0.98-1.02) | |||
Peripheral vascular disease (PVD) | <0.001 | 2.61 (2.11-3.21) | <0.001 | 1.99 (1.61-2.46) | |
Renal dysfunction | <0.001 | 2.34 (1.76-3.13) | <0.001 | 1.69 (1.26-2.27) | |
Chronic obstructive pulmonary disease (COPD) | <0.001 | 1.64 (1.38-1.97) | <0.001 | 1.67 (1.39-1.99) | |
Cerebrovascular accident (CVA) | <0.001 | 1.88 (1.40-2.53) | <0.001 | 1.71 (1.27-2.31) | |
Mechanical prosthetic valve | <0.001 | 0.46 (0.39-0.54) | 0.126 | 0.85 (0.70-1.05) | |
Concomitant coronary artery bypass grafting (CABG) | <0.001 | 1.58 (1.35-1.84) | 0.993 | 0.99 (0.83-1.21) | |
Cardiopulmonary bypass (CPB) time, min | <0.001 | 1.01 (1.00-1.01) | 0.001 | 1.01 (1.00-1.01) | |
Aortic cross-clamp time, min | <0.001 | 1.01 (1.00-1.01) | 0.385 | 1.00 (0.99-1.00) | |
Prosthesis-patient mismatch (PPM) (cut-off ≤0.85 cm2/m2) | 0.032 | 1.26 (1.02-1.55) | 0.235 | 1.14 (0.92-1.42) | |
Previous cardiac surgery | <0.001 | 1.58 (1.25-2.00) | 0.005 | 1.43 (1.11-.84) |
Long-term survival after AVR or AVR with CABG
Discussion
Variable | Early mortality | Late mortality |
---|---|---|
Age | + | + |
Severely impaired LV function (EF<30%) | + | + |
Diabetes Mellitus | − | + |
Endocarditis | + | − |
Peripheral vascular disease (PVD) | − | + |
Renal dysfunction | + | + |
Chronic obstructive pulmonary disease (COPD) | + | + |
Cerebrovascular accident (CVA) | − | + |
Cardiopulmonary bypass (CPB) time | + | + |
Previous cardiac surgery | − | + |