Dania Mohty1, Cyrille Boulogne2, Julien Magne2, Philippe Pibarot2, Najmeddine Echahidi2, Elisabeth Cornu2, Jean Dumesnil2, Marc Laskar2, Patrice Virot2, Victor Aboyans2. 1. From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.). dania.mohty@chu-limoges.fr. 2. From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
Abstract
BACKGROUND: Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis-patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS. METHODS AND RESULTS: Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm(2)). A PLF (indexed stroke volume ≤35 mL/m(2)) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area ≤0.85 cm(2)/m(2). The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P<0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P=0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5-4.45; P=0.0007). CONCLUSIONS: In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome.
BACKGROUND:Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis-patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS. METHODS AND RESULTS: Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm(2)). A PLF (indexed stroke volume ≤35 mL/m(2)) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area ≤0.85 cm(2)/m(2). The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P<0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P=0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5-4.45; P=0.0007). CONCLUSIONS: In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome.
Authors: Hannah Z R McConkey; Michael Marber; Amedeo Chiribiri; Philippe Pibarot; Simon R Redwood; Bernard D Prendergast Journal: Circ Cardiovasc Interv Date: 2019-08-16 Impact factor: 6.546