Michiel D Vriesendorp1, G Michael Deeb2, Michael J Reardon3, Bob Kiaii4, Vinayak Bapat5, Louis Labrousse6, Vivek Rao7, Joseph F Sabik8, Elizabeth Gearhart9, Robert J M Klautz10. 1. Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: M.D.Vriesendorp@lumc.nl. 2. Department of Cardiac Surgery, University of Michigan Health System-University Hospital, Ann Arbor, Mich. 3. Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex. 4. Department of Cardiovascular and Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada. 5. Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY. 6. Medico-Surgical Department of Valvulopathies, CHU Hospital of Bordeaux, Bordeaux, France. 7. Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada. 8. Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio. 9. Department of Biostatistics, Medtronic, Minneapolis, Minn. 10. Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: R.J.M.Klautz@lumc.nl.
Abstract
OBJECTIVES: Although the impact of prosthesis-patient mismatch (PPM) on survival has been widely studied, there has been little debate about whether the current definition of PPM truly reflects hemodynamic obstruction. This study aimed to validate the categorization of indexed effective orifice area (EOAi) for the classification of PPM. METHODS: In total, 2171 patients who underwent aortic valve replacement with a surgical stented bioprosthesis in 5 trials (CoreValve US High-Risk, SURTAVI [Surgical Replacement and Transcatheter Aortic Valve Implantation Trial], Evolut Low Risk, PERIGON [PERIcardial SurGical AOrtic Valve ReplacemeNt] Pivotal Trial for the Avalus valve, and PERIGON Japan) were used for this analysis. The echocardiographic images at the 1-year follow-up visit were evaluated to explore the association between EOAi and mean aortic gradient and its interaction with other patient characteristics, including obesity. In addition, different criteria of PPM were compared with reflect elevated mean aortic gradients (≥20 mm Hg). RESULTS: A relatively smaller exponential decay in mean aortic gradient was found for increasing EOAi, as the slope on the log scale was -0.83 versus -2.5 in the publication from which the current cut-offs for PPM originate. The accuracy of the American Society of Echocardiography, Valve Academic Research Consortium-2, and European Association of Cardiovascular Imaging definitions of PPM to reflect elevated mean aortic gradients was 49%, 57%, and 57%, respectively. The relation between EOAi and mean aortic gradient was not significantly different between obese and non-obese patients (P = .20). CONCLUSIONS: The use of EOAi thresholds to classify patients with PPM is undermined by a less-pronounced exponential relationship between EOAi and mean aortic gradient than previously demonstrated. Moreover, recent adjustment for obesity in the definition of PPM is not supported by these data.
OBJECTIVES: Although the impact of prosthesis-patient mismatch (PPM) on survival has been widely studied, there has been little debate about whether the current definition of PPM truly reflects hemodynamic obstruction. This study aimed to validate the categorization of indexed effective orifice area (EOAi) for the classification of PPM. METHODS: In total, 2171 patients who underwent aortic valve replacement with a surgical stented bioprosthesis in 5 trials (CoreValve US High-Risk, SURTAVI [Surgical Replacement and Transcatheter Aortic Valve Implantation Trial], Evolut Low Risk, PERIGON [PERIcardial SurGical AOrtic Valve ReplacemeNt] Pivotal Trial for the Avalus valve, and PERIGON Japan) were used for this analysis. The echocardiographic images at the 1-year follow-up visit were evaluated to explore the association between EOAi and mean aortic gradient and its interaction with other patient characteristics, including obesity. In addition, different criteria of PPM were compared with reflect elevated mean aortic gradients (≥20 mm Hg). RESULTS: A relatively smaller exponential decay in mean aortic gradient was found for increasing EOAi, as the slope on the log scale was -0.83 versus -2.5 in the publication from which the current cut-offs for PPM originate. The accuracy of the American Society of Echocardiography, Valve Academic Research Consortium-2, and European Association of Cardiovascular Imaging definitions of PPM to reflect elevated mean aortic gradients was 49%, 57%, and 57%, respectively. The relation between EOAi and mean aortic gradient was not significantly different between obese and non-obese patients (P = .20). CONCLUSIONS: The use of EOAi thresholds to classify patients with PPM is undermined by a less-pronounced exponential relationship between EOAi and mean aortic gradient than previously demonstrated. Moreover, recent adjustment for obesity in the definition of PPM is not supported by these data.
Authors: Robert J M Klautz; François Dagenais; Michael J Reardon; Rüdiger Lange; Michael G Moront; Louis Labrousse; Neil J Weissman; Vivek Rao; Himanshu J Patel; Fang Liu; Joseph F Sabik Journal: Eur J Cardiothorac Surg Date: 2022-08-03 Impact factor: 4.534