Background
Methods
Patient population and data collection
PPM definition and EOA index (EOAi) calculation
Valve prosthesis | patients | 23 mm | 25 mm | 27 mm | 29 mm | 31 mm | 33 mm | Ref |
---|---|---|---|---|---|---|---|---|
Mechanical | 868 | |||||||
CarboMedics Orbis Universal | 680 | 1.8 | 2.2 | 2.2 | 2.4 | 2.4 | 2.3 | [12] |
St.Jude Master series | 154 | 1.0 | 1.5 | 1.8 | 1.8 | 2.0 | 2.0 | |
ATS open pivot | 33 | – | 1.8 | 2.8 | 2.8 | 2.9 | 2.9 | [22] |
Bioprosthesis | 199 | |||||||
Medtronics Hancock II | 110 | – | 1.5 | 1.8 | 1.9 | 2.6 | 2.6 | [12] |
Medtronics Mosaic | 5 | – | 1.5 | 1.7 | 1.9 | 1.9 | – | [13] |
St. Jude Bicor Stented | 45 | – | 1.4 | 1.5 | 2.3 | 2.2 | 2.3 | [23] |
Carpentier-Edwards perimount | 39 | – | 1.7 | 1.9 | 2.3 | 2.8 | 2.7 | [12] |
Surgical technique and prosthesis application
Statistical analysis
Results
Preoperative data and baseline information
preoperative information | total (n = 1067) | PPM group (n = 189) | non-PPM group (n = 878) | P value |
---|---|---|---|---|
Age, y | 56(48–62) | 63(55–67) | 54(46–61) | < 0.001 |
Male | 379(35.5%) | 89(47.1%) | 290(33.0%) | < 0.001 |
Height, cm | 160.72 ± 7.82 | 163.26 ± 7.87 | 160.17 ± 7.71 | < 0.001 |
Weight, kg | 57.72 ± 10.33 | 62.42 ± 10.23 | 56.70 ± 10.07 | < 0.001 |
BMI, kg/m2 | 22.29 ± 3.67 | 23.34 ± 2.86 | 22.07 ± 3.79 | < 0.001 |
BSA, m2 | 1.57 ± 0.16 | 1.64 ± 0.17 | 1.55 ± 0.16 | < 0.001 |
Smoking history | 123(11.5%) | 32(16.9%) | 91(10.4%) | 0.016 |
Diabetes | 102(9.6%) | 22(11.6%) | 80(9.2%) | NS |
Hypertention | 192(18.0%) | 47(24.9%) | 145(16.5%) | 0.009 |
Cerebrovascular accident | 34(3.2%) | 6(3.2%) | 28(3.2%) | NS |
Coronary heart disease | 22(2.1%) | 9(4.8%) | 13(1.5%) | 0.009 |
NYHA functional class (≥ III) | 400(37.5%) | 77(40.7%) | 323(36.8%) | NS |
Atrial fibrillation | 533(50.0%) | 92(48.7%) | 441(50.2%) | NS |
Previous cardiac surgery | 54(5.1%) | 8(4.2%) | 46(5.2%) | NS |
Previous MI | 1(0.1%) | 0(0.0%) | 1(0.1%) | NS |
Mitral stenosis | 786(76.7%) | 128(67.7%) | 658(74.9%) | 0.036 |
MR (moderate to severe) | 470(44.0%) | 88(46.5%) | 382(43.5%) | NS |
LVEF | 62.11 ± 8.48 | 62.23 ± 8.95 | 62.09 ± 8.38 | NS |
LVdD, mm | 50(45–56) | 51(46–58) | 50(45–56) | NS |
LAD, mm | 51.36 ± 12.04 | 51.36 ± 11.93 | 51.36 ± 12.07 | NS |
Emergency surgery | 2(0.2%) | 0(0.0%) | 0(0.0%) | NS |
Aspirin within 5 days | 29(2.7%) | 9(4.8%) | 20(2.3%) | NS |
Clopidogrel within 5 days | 19(1.8%) | 6(3.2%) | 13(1.5%) | NS |
Patient characterize, PPM and valve prosthesis size
Operative data
total | PPM group n = 189 | non-PPM group n = 878 | P value | |
---|---|---|---|---|
First time surgery | 1013(94.9%) | 181(95.8%) | 832(94.7%) | NS |
CPB time (min) | 83(70–92) | 83(70–89) | 83(70–93) | NS |
Cross-clamp time (min) | 50(41–62) | 45(40–55) | 50(41–63) | < 0.001 |
Bioprosthesis | 199(18.7%) | 96(50.8%) | 103(11.7%) | < 0.001 |
Combined procedure | ||||
Tricuspid valve plasty | 277(26.0%) | 38(20.1%) | 239(27.2%) | NS |
CABG | 28(2.6%) | 11(5.8%) | 17(1.9%) | 0.005 |
AFRA or Maze surgery | 106(9.9%) | 30(15.9%) | 76(8.7%) | 0.005 |
Others | 139(13.0%) | 30(15.9%) | 109(12.4%) | NS |
Factors affecting PPM
Factors | mean or % | OR | 95% CI | P value |
---|---|---|---|---|
Age | 54 | 1.029 | 1.006–1.051 | 0.011 |
BSA (m2) | 1.57 | 152.111 | 45.261–511.208 | < 0.001 |
LVDd (mm) | 51.26 | 0.964 | 0.944–0.984 | < 0.001 |
bioprosthesis | 18.7% | 7.539 | 4.632–12.273 | < 0.001 |
Postoperative outcomes and factors affecting postoperative mortality
total | PPM group | non-PPM group | P | |
---|---|---|---|---|
Perioperative transfusion | 269(25.2%) | 47(24.9%) | 222(25.3%) | NS |
Ventilation time (hr) | 21(20–23) | 21(20–23) | 21(20–23) | NS |
Reintubation | 3(0.3%) | 0(0.0%) | 3(0.3%) | NS |
Duration of first time ICU | 72(72–96) | 72(72–96) | 72(72–96) | NS |
Reentering ICU | 2(0.2%) | 2(1.1%) | 0(0.0%) | NS |
Chest tube output (ml) | 545.88 ± 365.82 | 555.15 ± 295.51 | 543.87 ± 379.47 | NS |
Reoperation for bleeding | 18(1.7%) | 1(0.5%) | 17(1.9%) | NS |
Sternal wound infection | 3(0.3%) | 0(0.0%) | 3(0.3%) | NS |
Cerebral infarction | 5(0.5%) | 0(0.0%) | 5(0.6%) | NS |
Postoperative stroke | 1(0.1%) | 0(0.0%) | 1(0.1%) | NS |
Newly onset AF | 3(0.3%) | 0(0.0%) | 3(0.3%) | NS |
Mortality within 30 days | 9(0.8%) | 2(1.1%) | 7(0.8%) | NS |
Hospitalization expense (USD) | 13,726 (11632–16,030) | 14,446 (12538–17,010) | 13,628 (11509–15,775) | 0.032 |
Length of stay (d) | 14(12–18) | 15(13–19) | 14(12–18) | 0.011 |
Factors | mean or % | Odds ratio | 95% CI | P value |
---|---|---|---|---|
smoking history | 11.5% | 3.199 | 0.729–14.041 | 0.004 |
preoperative LVEF | 62.11 | 0.955 | 0.887–1.029 | 0.001 |
PPM | 17.7% | 1.138 | 0.226–5.743 | 0.654 |
Mid-term follow-up
Total | PPM group | non-PPM group | P value | |
---|---|---|---|---|
Follow-up time (months) | 31(23–35) | 32(24–35) | 31(23–33) | P = 0.362 |
NYHA functional class (III-IV) | 9.2% | 9.0% | 9.6% | P = 0.902 |
Mortality | 17(1.6%) | 3(1.6%) | 14(1.6%) | P = 0.994 |