Philippe Pibarot1, Matheus Simonato2, Marco Barbanti3, Axel Linke4, Ran Kornowski5, Tanja Rudolph6, Mark Spence7, Neil Moat8, Gabriel Aldea9, Marco Mennuni10, Alessandro Iadanza11, Hafid Amrane12, Diego Gaia2, Won-Keun Kim13, Massimo Napodano14, Hardy Baumbach15, Ariel Finkelstein16, Junjiro Kobayashi17, Stephen Brecker18, Creighton Don9, Alfredo Cerillo19, Axel Unbehaun20, David Attias21, Mohammed Nejjari21, Noah Jones22, Claudia Fiorina23, Didier Tchetche24, Raphael Philippart24, Konstantinos Spargias25, Jose-Maria Hernandez26, Azeem Latib27, Danny Dvir9. 1. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada. Electronic address: philippe.pibarot@med.ulaval.ca. 2. Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil. 3. Ferraroto Hospital, Catania, Italy. 4. Universität Leipzig, Leipzig, Germany. 5. Rabin Medical Center, Petah Tikva, Israel. 6. Uniklinik Köln Herzzentrum, Cologne, Germany. 7. Belfast Health and Social Care Trust, Belfast, United Kingdom. 8. Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom. 9. University of Washington, Seattle, Washington. 10. Humanitas Hospital, Milan, Italy. 11. Azienda Ospedaliera Universitaria Senese, Siena, Italy. 12. Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands. 13. Kerckhoff Klinik, Bad Nauheim, Germany. 14. University of Padova, Padova, Italy. 15. Robert-Bosch-Krankenhaus, Stuttgart, Germany. 16. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 17. National Cerebral and Cardiovascular Center, Osaka, Japan. 18. St. George's, University of London, London, United Kingdom. 19. Fondazione Toscana Gabriele Monasterio, Pisa, Italy. 20. Deutsches Herzzentrum Berlin, Berlin, Germany. 21. Centre Cardiologique du Nord, Saint Denis, France. 22. Mount Carmel Columbus, Columbus, Ohio. 23. Spedali Civili di Brescia, Brescia, Italy. 24. Clinique Pasteur, Toulouse, France. 25. Hygeia Hospital, Athens, Greece. 26. Hospital Universitario Virgen de la Victoria, Malaga, Spain. 27. Ospedale di San Raffaele, Milan, Italy.
Abstract
OBJECTIVES: The aim of this study was to determine whether the association of small label size of the surgical valve with increased mortality after transcatheter valve-in-valve (ViV) implantation is, at least in part, related to pre-existing prosthesis-patient mismatch (PPM) (i.e., a bioprosthesis that is too small in relation to body size). BACKGROUND: Transcatheter ViV implantation is an alternative for the treatment of patients with degenerated bioprostheses. Small label size of the surgical valve has been associated with increased mortality after ViV implantation. METHODS: Data from 1,168 patients included in the VIVID (Valve-in-Valve International Data) registry were analyzed. Pre-existing PPM of the surgical valve was determined using a reference value of effective orifice area for each given model and size of implanted prosthetic valve indexed for body surface area. Severe PPM was defined according to the criteria proposed by the Valve Academic Research Consortium 2: indexed effective orifice area <0.65 cm2/m2 if body mass index is <30 kg/m2 and <0.6 cm2/m2 if BMI is ≥30 kg/m2. The primary study endpoint was 1-year mortality. RESULTS: Among the 1,168 patients included in the registry, 89 (7.6%) had pre-existing severe PPM. Patients with severe PPM had higher 30-day (10.3%, p = 0.01) and 1-year (unadjusted: 28.6%, p < 0.001; adjusted: 19.3%, p = 0.03) mortality rates compared with patients with no severe PPM (4.3%, 11.9%, and 10.9%, respectively). After adjusting for surgical valve label size, Society of Thoracic Surgeons score, renal failure, diabetes, and stentless surgical valves, presence of pre-existing severe PPM was associated with increased risk for 1-year mortality (odds ratio: 1.88; 95% confidence interval: 1.07 to 3.28; p = 0.03). Patients with severe PPM also more frequently harbored high post-procedural gradients (mean gradient ≥20 mm Hg). CONCLUSIONS: Pre-existing PPM of the failed surgical valve is strongly and independently associated with increased risk for mortality following ViV implantation.
OBJECTIVES: The aim of this study was to determine whether the association of small label size of the surgical valve with increased mortality after transcatheter valve-in-valve (ViV) implantation is, at least in part, related to pre-existing prosthesis-patient mismatch (PPM) (i.e., a bioprosthesis that is too small in relation to body size). BACKGROUND: Transcatheter ViV implantation is an alternative for the treatment of patients with degenerated bioprostheses. Small label size of the surgical valve has been associated with increased mortality after ViV implantation. METHODS: Data from 1,168 patients included in the VIVID (Valve-in-Valve International Data) registry were analyzed. Pre-existing PPM of the surgical valve was determined using a reference value of effective orifice area for each given model and size of implanted prosthetic valve indexed for body surface area. Severe PPM was defined according to the criteria proposed by the Valve Academic Research Consortium 2: indexed effective orifice area <0.65 cm2/m2 if body mass index is <30 kg/m2 and <0.6 cm2/m2 if BMI is ≥30 kg/m2. The primary study endpoint was 1-year mortality. RESULTS: Among the 1,168 patients included in the registry, 89 (7.6%) had pre-existing severe PPM. Patients with severe PPM had higher 30-day (10.3%, p = 0.01) and 1-year (unadjusted: 28.6%, p < 0.001; adjusted: 19.3%, p = 0.03) mortality rates compared with patients with no severe PPM (4.3%, 11.9%, and 10.9%, respectively). After adjusting for surgical valve label size, Society of Thoracic Surgeons score, renal failure, diabetes, and stentless surgical valves, presence of pre-existing severe PPM was associated with increased risk for 1-year mortality (odds ratio: 1.88; 95% confidence interval: 1.07 to 3.28; p = 0.03). Patients with severe PPM also more frequently harbored high post-procedural gradients (mean gradient ≥20 mm Hg). CONCLUSIONS: Pre-existing PPM of the failed surgical valve is strongly and independently associated with increased risk for mortality following ViV implantation.
Authors: R Yazan Kherallah; Srikanth Koneru; Zvonimir Krajcer; Ourania Preventza; Kathryn G Dougherty; Melissa L McCormack; Briana T Costello; Stephanie Coulter; Neil E Strickman; Juan Carlos Plana Gomez; Ali Mortazavi; Jose G Díez; James J Livesay; Joseph S Coselli; Guilherme V Silva Journal: Ann Cardiothorac Surg Date: 2021-09
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Authors: Pier Pasquale Leone; Fabio Fazzari; Francesco Cannata; Jorge Sanz-Sanchez; Antonio Mangieri; Lorenzo Monti; Ottavia Cozzi; Giulio Giuseppe Stefanini; Renato Bragato; Antonio Colombo; Bernhard Reimers; Damiano Regazzoli Journal: Front Cardiovasc Med Date: 2021-06-04
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Authors: Andrea Buono; Diego Maffeo; Giovanni Troise; Francesco Donatelli; Maurizio Tespili; Alfonso Ielasi Journal: J Clin Med Date: 2022-01-11 Impact factor: 4.241