ࡱ>  wxyz{|}~#`bjbj5G5GW-W- &65556t C6F c"dddfsodq4$ htÖf@fÖÖddcccÖdd`cÖccdF  HA5פ3, 0_pӵ8XU| sf q~$c s s s X s s sÖÖÖÖ6d**>dX6**>666  Aortic Valve Replacement The Influence of Prosthesis-Patient Mismatch for Left Ventricular Remodeling, Cardiac Function and Survival Shahab Nozohoor, M.D. Department of Cardiothoracic Surgery Faculty of Medicine Lund University, 2009 Doctoral Dissertation Department of cardiothoracic Surgery Faculty of Medicine Lund University SE-221 85 Lund SWEDEN Shahab Nozohoor, 2009 (pages 1-80) Lund University Printed by Media-Tryck, Lund, 2009 ISBN 978-91-86253-87-5 Dedicated to Ann and Saga, the noor of my eyes "A Parisian tailor, not yet old, having dined and left his house had walked hardly 40 paces when he suddenly fell to the ground and expired. His body was opened and no disease found except that the three semilunar cusps leading to the aorta were bony". Thofile Bonet, 1679  TOC \o "1-6" \h \z \u   HYPERLINK \l "_Toc242082156" List of Publications  PAGEREF _Toc242082156 \h 7  HYPERLINK \l "_Toc242082157" Abstract  PAGEREF _Toc242082157 \h 8  HYPERLINK \l "_Toc242082158" Abbreviations  PAGEREF _Toc242082158 \h 9  HYPERLINK \l "_Toc242082159" Introduction  PAGEREF _Toc242082159 \h 10  HYPERLINK \l "_Toc242082160" 1.1 Prosthesis-patient mismatch the concept  PAGEREF _Toc242082160 \h 10  HYPERLINK \l "_Toc242082161" 1.2 Classification of PPM  PAGEREF _Toc242082161 \h 10  HYPERLINK \l "_Toc242082162" 1.3 Determinants of prosthesis-patient mismatch  PAGEREF _Toc242082162 \h 11  HYPERLINK \l "_Toc242082163" 1.4 Hemodynamic impact of prosthesis-patient mismatch  PAGEREF _Toc242082163 \h 11  HYPERLINK \l "_Toc242082164" 1.5 The clinical influence of prosthesis-patient mismatch  PAGEREF _Toc242082164 \h 14  HYPERLINK \l "_Toc242082165" 1.5.1 Survival  PAGEREF _Toc242082165 \h 14  HYPERLINK \l "_Toc242082166" 1.5.2 Prosthesis-patient mismatch and morbidity  PAGEREF _Toc242082166 \h 15  HYPERLINK \l "_Toc242082167" 1.5.3 Prosthesis-patient mismatch and BMI  PAGEREF _Toc242082167 \h 16  HYPERLINK \l "_Toc242082168" 1.5.4 Prosthesis-patient mismatch and in vivo EOA  PAGEREF _Toc242082168 \h 16  HYPERLINK \l "_Toc242082169" 1.5.5 Severe prosthesis-patient mismatch  PAGEREF _Toc242082169 \h 18  HYPERLINK \l "_Toc242082170" 1.5.6 Homogeneity and propensity scoring  PAGEREF _Toc242082170 \h 18  HYPERLINK \l "_Toc242082171" 1.5.7 Prosthesis-patient mismatch and left ventricular mass regression  PAGEREF _Toc242082171 \h 19  HYPERLINK \l "_Toc242082172" 1.5.8 Prosthesis-patient mismatch quality of life  PAGEREF _Toc242082172 \h 20  HYPERLINK \l "_Toc242082173" 1.5.9 Prosthesis-patient mismatch and aortic valve insufficiency  PAGEREF _Toc242082173 \h 20  HYPERLINK \l "_Toc242082174" 1.6 Postoperative heart failure  PAGEREF _Toc242082174 \h 20  HYPERLINK \l "_Toc242082175" 1.7 Diastolic dysfunction in patients with aortic valve disease  PAGEREF _Toc242082175 \h 21  HYPERLINK \l "_Toc242082176" 1.8 Brain-type natriuretic peptide  PAGEREF _Toc242082176 \h 22  HYPERLINK \l "_Toc242082177" 1.8.1 Preoperative measurement of brain-type natriuretic peptide in aortic valve stenosis  PAGEREF _Toc242082177 \h 22  HYPERLINK \l "_Toc242082178" 1.8.2 Measurement of brain-type natriuretic peptide following aortic valve replacement  PAGEREF _Toc242082178 \h 23  HYPERLINK \l "_Toc242082179" 1.9 Aortic valve stenosis  PAGEREF _Toc242082179 \h 23  HYPERLINK \l "_Toc242082180" 1.9.1 Pathophysiology  PAGEREF _Toc242082180 \h 23  HYPERLINK \l "_Toc242082181" 1.10 Aortic valve insufficiency  PAGEREF _Toc242082181 \h 24  HYPERLINK \l "_Toc242082182" 1.10.1 Acute aortic valve insufficiency  PAGEREF _Toc242082182 \h 24  HYPERLINK \l "_Toc242082183" 1.10.2 Chronic aortic valve insufficiency  PAGEREF _Toc242082183 \h 25  HYPERLINK \l "_Toc242082184" 1.11 Aortic valve replacement  PAGEREF _Toc242082184 \h 25  HYPERLINK \l "_Toc242082185" 1.12 The small aortic root and alternative surgical strategies  PAGEREF _Toc242082185 \h 27  HYPERLINK \l "_Toc242082186" Aims of this Research  PAGEREF _Toc242082186 \h 29  HYPERLINK \l "_Toc242082187" Material and Methods  PAGEREF _Toc242082187 \h 30  HYPERLINK \l "_Toc242082188" 3.1 Patients  PAGEREF _Toc242082188 \h 30  HYPERLINK \l "_Toc242082189" 3.2 Study design  PAGEREF _Toc242082189 \h 30  HYPERLINK \l "_Toc242082190" 3.2.1 Paper I  PAGEREF _Toc242082190 \h 30  HYPERLINK \l "_Toc242082191" 3.2.2 Paper II  PAGEREF _Toc242082191 \h 31  HYPERLINK \l "_Toc242082192" 3.2.3 Paper III  PAGEREF _Toc242082192 \h 31  HYPERLINK \l "_Toc242082193" 3.2.4 Paper IV  PAGEREF _Toc242082193 \h 31  HYPERLINK \l "_Toc242082194" 3.3 Anesthetic management  PAGEREF _Toc242082194 \h 32  HYPERLINK \l "_Toc242082195" 3.4 Surgical management  PAGEREF _Toc242082195 \h 32  HYPERLINK \l "_Toc242082196" 3.5 Triage BNP test  PAGEREF _Toc242082196 \h 32  HYPERLINK \l "_Toc242082197" 3.6 Echocardiography  PAGEREF _Toc242082197 \h 33  HYPERLINK \l "_Toc242082198" 3.7 Definitions  PAGEREF _Toc242082198 \h 34  HYPERLINK \l "_Toc242082199" 3.8 Statistical analyses  PAGEREF _Toc242082199 \h 34  HYPERLINK \l "_Toc242082200" 3.9 Ethical aspects  PAGEREF _Toc242082200 \h 35  HYPERLINK \l "_Toc242082201" Results  PAGEREF _Toc242082201 \h 36  HYPERLINK \l "_Toc242082202" 4.1 Impact of patient-prosthesis mismatch on in-hospital complications  PAGEREF _Toc242082202 \h 36  HYPERLINK \l "_Toc242082203" 4.2 Risk factors for postoperative neurological events  PAGEREF _Toc242082203 \h 36  HYPERLINK \l "_Toc242082204" 4.3 Left ventricular mass regression and diastolic dysfunction  PAGEREF _Toc242082204 \h 37  HYPERLINK \l "_Toc242082205" 4.4 Left ventricular remodeling following AVR for severe aortic valve insufficiency  PAGEREF _Toc242082205 \h 39  HYPERLINK \l "_Toc242082206" 4.5 Predictors of postoperative heart failure  PAGEREF _Toc242082206 \h 41  HYPERLINK \l "_Toc242082207" 4.6 Impact of PPM on early mortality  PAGEREF _Toc242082207 \h 41  HYPERLINK \l "_Toc242082208" 4.7 Impact of PPM on late mortality  PAGEREF _Toc242082208 \h 43  HYPERLINK \l "_Toc242082209" 4.8 Postoperative appearance of BNP and the relation between BNP and PPM  PAGEREF _Toc242082209 \h 44  HYPERLINK \l "_Toc242082210" Discussion  PAGEREF _Toc242082210 \h 45  HYPERLINK \l "_Toc242082211" 5.1 Postoperative morbidity  PAGEREF _Toc242082211 \h 45  HYPERLINK \l "_Toc242082212" 5.2 Impact of PPM on early mortality  PAGEREF _Toc242082212 \h 46  HYPERLINK \l "_Toc242082213" 5.3 Postoperative heart failure  PAGEREF _Toc242082213 \h 47  HYPERLINK \l "_Toc242082214" 5.4 Impact of PPM on diastolic heart failure  PAGEREF _Toc242082214 \h 48  HYPERLINK \l "_Toc242082215" 5.5 Stented bioprostheses for supra-annular implantation  PAGEREF _Toc242082215 \h 49  HYPERLINK \l "_Toc242082216" 5.6 Impact of PPM on LV remodeling in aortic valve insufficiency  PAGEREF _Toc242082216 \h 50  HYPERLINK \l "_Toc242082217" 5.7 Impact of PPM on mortality  PAGEREF _Toc242082217 \h 51  HYPERLINK \l "_Toc242082218" 5.8 General discussion  PAGEREF _Toc242082218 \h 53  HYPERLINK \l "_Toc242082219" 5.9 Limitations  PAGEREF _Toc242082219 \h 55  HYPERLINK \l "_Toc242082220" Future perspectives  PAGEREF _Toc242082220 \h 56  HYPERLINK \l "_Toc242082221" Conclusions  PAGEREF _Toc242082221 \h 57  HYPERLINK \l "_Toc242082222" Populrvetenskaplig sammanfattning (Summary in Swedish)  PAGEREF _Toc242082222 \h 58  HYPERLINK \l "_Toc242082223" Acknowledgements  PAGEREF _Toc242082223 \h 61  HYPERLINK \l "_Toc242082224" References  PAGEREF _Toc242082224 \h 63  HYPERLINK \l "_Toc242082225" Papers I-IV  PAGEREF _Toc242082225 \h 81  List of Publications This thesis is based on the following papers, which are referred to in the text by their Roman numerals: I. Nozohoor S, Nilsson J, Lhrs C, Roijer A, Sjgren J. The Influence of Patient-Prosthesis Mismatch on In-hospital Complications and Early Mortality after Aortic Valve Replacement. Journal of Heart Valve Disease 2007;16:475-482. II. Nozohoor S, Nilsson J, Lhrs C, Roijer A, Algotsson L, Sjgren J. B-type Natriuretic Peptide as a Predictor of Postoperative Heart Failure following Aortic Valve Replacement. Journal of Cardiothoracic and Vascular Anesthesia 2009;23:161-165. III. Nozohoor S, Nilsson J, Lhrs C, Roijer A, Sjgren J. Influence of Prosthesis-Patient Mismatch on Diastolic Heart Failure after Aortic Valve Replacement. The Annals of Thoracic Surgery 2008;85:1310-1317. IV. Nozohoor S, Nilsson J, Lhrs C, Roijer A, Sjgren J. Influence of Prosthesis-Patient Mismatch on Left Ventricular Remodeling in Severe Aortic Insufficiency. European Journal of Cardiothoracic Surgery, online publication: 19-AUG-2009; DOI: 10.1016/j.ejcts.2009.07.009 Abstract Valve substitution due to aortic valve disease corrects anatomical defects, promotes regression of myocardial hypertrophy, recovery of left ventricular performance, and remission of symptoms. However, the best valve substitute in terms of hemodynamic performance, durability, incidence of complications, and survival remains the subject of much debate. It has been suggested that valve performance is influenced by the potentially modifiable variable prosthesis-patient mismatch (PPM). PPM has been reported to be detrimental for survival and symptom resolution mainly due to the promotion of unfavorable prosthesis hemodynamics with secondary impaired left ventricular remodeling. Nevertheless, an increasing number of studies with various study designs and outcomes present conflicting results. Thus, there is no convincing evidence for PPMs detrimental effects. The aims of this research were to evaluate the impact of PPM on in-hospital complications and survival, to analyze whether postoperative heart failure can be detected using brain-type natriuretic peptide (BNP) as a predictive biomarker, to investigate the influence of PPM in bioprostheses with respect to recovery of left ventricular diastolic function and left ventricular mass regression, and to evaluate the influence of prosthesis-patient mismatch on left ventricular remodeling following aortic valve replacement for severe valve insufficiency. The present work demonstrated that PPM was not associated with low cardiac output syndrome, but rather an independent risk factor for a neurological event during the postoperative period after valve replacement. This finding probably reflects a more cumbersome surgical procedure in a small aortic root with extensive calcification, commonly observed in patients with native valvular stenosis. PPM had no impact on either early or late mortality. Postoperative heart failure following AVR was associated with a high early postoperative mortality and was predicted by elevated BNP levels on arrival in the ICU although the discriminatory ability of the biomarker was poor. PPM did not impair left ventricular mass regression or the recovery of diastolic function. PPM was surprisingly common in patients with severe aortic insufficiency undergoing AVR. In these patients, left ventricular remodeling was initiated regardless of preoperative left ventricular ejection fraction or PPM. In conclusion, the clinical relevance and the prevention of PPM seem subordinate and to improve patient outcome, priority should be given to the design of a durable, non-thrombogenic prosthesis permitting easy handling and reducing surgical complexity. Abbreviations AS aortic stenosis AVR aortic valve replacement AVI aortic valve insufficiency BNP brain-type natriuretic peptide BSA body surface area CABG coronary artery by-pass grafting CFR coronary flow reserve CPB cardiopulmonary bypass COPD chronic obstructive pulmonary disease CVI cerebrovascular insult DHF diastolic heart failure EOA effective orifice area EOAi indexed effective orifice area (EOA/BSA) GOA geometric orifice area GOAi indexed geometric orifice area (GOA/BSA) IABP intra-aortic balloon pump ICU intensive care unit IVSd interventricular septum at end-diastole LA left atrium dimension at end-systole in parasternal long axis view LCOS low cardiac output syndrome LFLG AS low-flow, low-gradient aortic stenosis LPWDd left ventricular posterior wall dimension at end-diastole LV left ventricle LVEDD left ventricular end-diastolic diameter LVESD left ventricular end-systolic diameter LVEF left ventricular ejection fraction LVH left ventricular hypertrophy LVIDd left ventricular internal dimension in diastole LVMI left ventricular mass index LVMR left ventricular mass regression LVOT left ventricular outflow tract MI myocardial infarction PHF postoperative heart failure PPM prosthesis-patient mismatch QoL quality of life ROC receiver operating characteristic SVD structural valve deterioration TPG transprosthetic gradient TVI time-velocity integral Introduction 1.1 Prosthesis-patient mismatch the concept Prosthesis-patient mismatch (PPM) was first described by Rahimtoola in 1978  ADDIN REFMGR.CITE Rahimtoola1978306The problem of valve prosthesis-patient mismatchJournal306The problem of valve prosthesis-patient mismatchRahimtoola,S.H.1978adverse effectsanatomy & histologyConstriction,PathologicetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart ValvesHemodynamic ProcessesHumanspathologyphysiopathologyNot in File2024Circulation58PM:348341Circulation1(1) who stated that mismatch can be considered present when the effective prosthetic valve area, after insertion into the patient, is less than that of a normal human valve. Rahimtoola suggested that the degree of PPM could be quantified, which would aid in identifying patients at risk of clinical sequelae caused by this condition. The pathophysiology of mismatch was subsequently proposed to be related to persistent valve gradients based on in vitro studies conducted by Dumesnil and Yoganathan  ADDIN REFMGR.CITE Dumesnil19928Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradientsJournal8Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradientsDumesnil,J.G.Yoganathan,A.P.1992Aortic ValveBioprosthesisBlood PressureBody Surface AreaclassificationEvaluation Studies as TopicExerciseHeart Valve ProsthesisHemodynamicsHumansMitral ValvephysiologyProsthesis FailurestandardsStroke VolumesurgeryNot in FileS34S37Eur J Cardiothorac.Surg6 Suppl 1
Quebec Heart Institute, Laval University, Canada
PM:1389276Eur J Cardiothorac.Surg1(2). They demonstrated an exponential relationship between the mean transprosthetic pressure gradient and the indexed effective orifice area (EOAi, i.e. PPM) for aortic bioprostheses in an in vitro physiologic pulse-duplicator system. Their findings led to the recommendation that the EOAi should ideally not be less than 0.9 to 1 cm2/m2 for aortic bioprostheses to minimize residual postoperative transprosthetic pressure gradients. This subsequently led to the premise that there may be a correlation between the decrease in transvalvular gradient and the clinical improvement seen after surgery  ADDIN REFMGR.CITE Pibarot199671The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical statusJournal71The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical statusPibarot,P.Honos,G.N.Durand,L.G.Dumesnil,J.G.1996adverse effectsAngina PectorisAortic ValveBioprosthesisBody Surface AreaEchocardiography,DoppleretiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHemodynamic ProcessesHumansMalephysiologyPrognosisProspective StudiesProsthesis FailurePulmonary EdemaResearch Support,Non-U.S.Gov'tstandardsSyncopeNot in File379387Can.J.Cardiol.12
Institue de recherches cliniques de Montreal, Quebec. pibarop@ircm.umontreal.ca
PM:8608457Can.J.Cardiol.1Gonzalez-Juanatey199610Influence of the size of aortic valve prostheses on hemodynamics and change in left ventricular mass: implications for the surgical management of aortic stenosisJournal10Influence of the size of aortic valve prostheses on hemodynamics and change in left ventricular mass: implications for the surgical management of aortic stenosisGonzalez-Juanatey,J.R.Garcia-Acuna,J.M.Vega,Fernandez M.Amaro,Cendon A.Castelo,Fuentes,VGarcia-Bengoechea,J.B.de la Pena,M.G.1996AgedAortic ValveAortic Valve StenosisBioprosthesisBlood PressureBody Surface AreaCardiac OutputEchocardiographyEchocardiography,DoppleretiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHemodynamicsHumansHypertrophy,Left VentricularMaleMiddle Agedpathologyprevention & controlProsthesis DesignSex FactorsSurface PropertiessurgerySystoleVentricular Function,LeftVentricular Outflow ObstructionNot in File273280J Thorac Cardiovasc Surg112
Department of Cardiology, Galician General Hospital, Spain
PM:8751490J Thorac Cardiovasc Surg1(3;4). With the development of Doppler echocardiography, in vivo observations demonstrated that normally functioning valve prostheses could have relatively high postoperative transvalvular gradients corresponding to the phenomenon previously referred to as prosthesispatient mismatch  ADDIN REFMGR.CITE Dumesnil19907Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyJournal7Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyDumesnil,J.G.Honos,G.N.Lemieux,M.Beauchemin,J.1990AgedAortic ValveAortic Valve StenosisBioprosthesisBody Surface AreadiagnosisEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHumansMaleMitral ValvePostoperative PeriodProsthesis DesignsurgeryNot in File637643J Am.Coll.Cardiol.16
Quebec Heart Institute, Laval University, Sainte-Foy, Canada
PM:2387937J Am.Coll.Cardiol.1David199211Clinical and hemodynamic assessment of the Hancock II bioprosthesisJournal11Clinical and hemodynamic assessment of the Hancock II bioprosthesisDavid,T.E.Armstrong,S.Sun,Z.1992Actuarial AnalysisAgedAortic ValveBioprosthesisEchocardiographyEndocarditisepidemiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHemodynamicsHumansMaleMiddle AgedMitral ValvemortalityPostoperative ComplicationsProsthesis DesignProsthesis FailureReoperationsurgerySurvival AnalysisTreatment OutcomeNot in File661667Ann.Thorac Surg54
Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada
PM:1417221Ann.Thorac Surg1Pibarot199865Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valveJournal65Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valvePibarot,P.Dumesnil,J.G.Lemieux,M.Cartier,P.Metras,J.Durand,L.G.1998adverse effectsAgedAortic ValveBioprosthesisBody Surface AreaCardiac OutputCohort StudiesComparative StudydiagnosisDisease-Free SurvivalEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHemodynamic ProcessesHumansMaleMiddle AgedmortalityphysiologyphysiopathologyPrognosisProspective StudiesProsthesis FailureProsthesis FittingResearch Support,Non-U.S.Gov'tsurgeryultrasonographyNot in File211218J.Heart Valve Dis.7
Department of Cardiology, Quebec Heart Institute, Ste Foy, Canada
PM:9587864J.Heart Valve Dis.1(5-7). PPM was suggested to occur more often in patients with large body surface area (BSA), in whom a high cardiac output across a small orifice area may produce high transprosthetic gradients  ADDIN REFMGR.CITE Rahimtoola1978306The problem of valve prosthesis-patient mismatchJournal306The problem of valve prosthesis-patient mismatchRahimtoola,S.H.1978adverse effectsanatomy & histologyConstriction,PathologicetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart ValvesHemodynamic ProcessesHumanspathologyphysiopathologyNot in File2024Circulation58PM:348341Circulation1Schaff1981110Clinical and hemodynamic evaluation of the 19 mm Bjork-Shiley aortic valve prosthesisJournal110Clinical and hemodynamic evaluation of the 19 mm Bjork-Shiley aortic valve prosthesisSchaff,H.V.Borkon,A.M.Hughes,C.Achuff,S.Donahoo,J.S.Gardner,T.J.Watkins,L.,Jr.Gott,V.L.Morrow,A.G.Brawley,R.K.1981Actuarial AnalysisAdolescentAdultAgedAortic ValveBody Surface AreaChildEchocardiographyEvaluation Studies as TopicFemaleFollow-Up StudiesHeartHeart CatheterizationHeart Valve ProsthesisHemodynamicsHospital MortalityHumansMaleMiddle AgedmortalityNot in File5057Ann Thorac Surg32PM:7247561The Annals of Thoracic SurgeryAnn Thorac Surg1(1;8). Hence, the calculated effective orifice area (EOA) of a specific prosthesis has frequently been adjusted for BSA to ensure its hemodynamic performance for an individual patient. The most widely accepted and validated parameter for identifying PPM is the indexed EOA, which is the EOA of the prosthesis divided by the patients BSA  ADDIN REFMGR.CITE Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1Pibarot200613Prosthesis-patient mismatch: definition, clinical impact, and preventionJournal13Prosthesis-patient mismatch: definition, clinical impact, and preventionPibarot,P.Dumesnil,J.G.2006Aortic ValveBlood Loss,SurgicalBody SizeetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansmortalityPostoperative ComplicationsProsthesis DesignProsthesis FittingResearch Support,Non-U.S.Gov'tRisk FactorssurgeryTreatment OutcomeVentricular Dysfunction,LeftNot in File10221029Heart92
Research Group in Valvular Heart Disease, Laval Hospital Research Centre/Quebec Heart Institute, Laval University, Sainte-Foy, Quebec, Canada. philippe.pibarot@med.ulaval.ca
PM:16251232Heart1(9;10). Prosthesispatient mismatch has been recognized as a functional hemodynamic abnormality rather than being due to an intrinsic defect of the prosthesis and is identified as a nonstructural dysfunction by the Society of Thoracic Surgeons  ADDIN REFMGR.CITE Edmunds1996340Guidelines for reporting morbidity and mortality after cardiac valvular operations.Journal340Guidelines for reporting morbidity and mortality after cardiac valvular operations.Edmunds,JrClark,Richard E.Cohn,Lawrence H.Grunkemeier,Gary L.Miller,D.CraigWeisel,Richard D.1996mortalityNot in File708711The Journal of Thoracic and Cardiovascular Surgery112http://www.sciencedirect.com/science/article/B6WMF-4HG1C0T-N/2/dee58b71c211661487a758ddc0dc7e0bThe Journal of Thoracic and Cardiovascular Surgery1(11). Previous studies have demonstrated that mismatch is a common phenomenon when using a relatively conservative definition (i.e., EOAid"0.85 cm2/m2), observed in 20 to 70% whereas the prevalence of severe PPM ranges from 2 to 10%  ADDIN REFMGR.CITE <Refman><Cite><Author>Pibarot</Author><Year>2000</Year><RecNum>50</RecNum><IDText>Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1Blais20033Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementJournal3Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementBlais,C.Dumesnil,J.G.Baillot,R.Simard,S.Doyle,D.Pibarot,P.2003adverse effectsAgedAortic ValveBody SizeCohort StudiesepidemiologyFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansIntraoperative PeriodMalemortalityMultivariate AnalysisOdds RatioOutcome Assessment (Health Care)physiopathologyPostoperative PeriodProspective StudiesQuebecReference ValuesResearch Support,Non-U.S.Gov'tRisk AssessmentRisk Factorsstandardsstatistics & numerical dataStroke VolumesurgeryTimeVascular PatencyNot in File983988Circulation108
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada
PM:12912812Circulation1(9;12). 1.2 Classification of PPM It has previously been demonstrated by Pibarot et al.  ADDIN REFMGR.CITE Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1(9) that the relation between the transprosthetic gradients and the EOAi is nonlinear and that the gradient increases exponentially when the EOAi falls below 0.8 to 0.9 cm2/m2 as shown in Figure 1.1. The value of EOAid"0.85 cm2/m2 is thus generally regarded as the threshold for PPM with values between 0.65 and 0.85 cm2/m2 being classified as moderate PPM and <0.65 cm2/m2 as severe PPM  ADDIN REFMGR.CITE <Refman><Cite><Author>Pibarot</Author>200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1Dumesnil19907Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyJournal7Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyDumesnil,J.G.Honos,G.N.Lemieux,M.Beauchemin,J.1990AgedAortic ValveAortic Valve StenosisBioprosthesisBody Surface AreadiagnosisEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHumansMaleMitral ValvePostoperative PeriodProsthesis DesignsurgeryNot in File637643J Am.Coll.Cardiol.16
Quebec Heart Institute, Laval University, Sainte-Foy, Canada
PM:2387937J Am.Coll.Cardiol.1Dumesnil19923Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradientsJournal3Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradientsDumesnil,J.G.Yoganathan,A.P.1992Aortic ValvesurgeryBioprosthesisclassificationstandardsBlood PressurephysiologyEvaluation Studies as TopicExerciseHeart Valve ProsthesisHemodynamicsHumansMitral ValveProsthesis FailureStroke VolumeNot in FileS34S37Eur J Cardiothorac.Surg6 Suppl 1
Quebec Heart Institute, Laval University, Canada
PM:1389276Eur J Cardiothorac.Surg1Pibarot199671The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical statusJournal71The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical statusPibarot,P.Honos,G.N.Durand,L.G.Dumesnil,J.G.1996adverse effectsAngina PectorisAortic ValveBioprosthesisBody Surface AreaEchocardiography,DoppleretiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHemodynamic ProcessesHumansMalephysiologyPrognosisProspective StudiesProsthesis FailurePulmonary EdemaResearch Support,Non-U.S.Gov'tstandardsSyncopeNot in File379387Can.J.Cardiol.12
Institue de recherches cliniques de Montreal, Quebec. pibarop@ircm.umontreal.ca
PM:8608457Can.J.Cardiol.1Pibarot199865Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valveJournal65Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valvePibarot,P.Dumesnil,J.G.Lemieux,M.Cartier,P.Metras,J.Durand,L.G.1998adverse effectsAgedAortic ValveBioprosthesisBody Surface AreaCardiac OutputCohort StudiesComparative StudydiagnosisDisease-Free SurvivalEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHemodynamic ProcessesHumansMaleMiddle AgedmortalityphysiologyphysiopathologyPrognosisProspective StudiesProsthesis FailureProsthesis FittingResearch Support,Non-U.S.Gov'tsurgeryultrasonographyNot in File211218J.Heart Valve Dis.7
Department of Cardiology, Quebec Heart Institute, Ste Foy, Canada
PM:9587864J.Heart Valve Dis.1(3;5;7;9;13).  SHAPE \* MERGEFORMAT  Figure 1.1 Correlation between mean transvalvular gradient and indexed effective orifice area in patients with a stented bioprosthesis (dots), a stentless bioprosthesis (circles), an aortic homograft (triangles), and a pulmonary autograft (squares). Reproduced from Pibarot and Dumesnil  ADDIN REFMGR.CITE Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1(9). 1.3 Determinants of prosthesis-patient mismatch Mismatch has been shown to occur more frequently in patients receiving a small prosthesis, in those with valvular stenosis as the predominant lesion before the operation, and in patients with a high BSA, and greater age  ADDIN REFMGR.CITE Rahimtoola1978306The problem of valve prosthesis-patient mismatchJournal306The problem of valve prosthesis-patient mismatchRahimtoola,S.H.1978adverse effectsanatomy & histologyConstriction,PathologicetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart ValvesHemodynamic ProcessesHumanspathologyphysiopathologyNot in File2024Circulation58PM:348341Circulation1Dumesnil19928Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradientsJournal8Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradientsDumesnil,J.G.Yoganathan,A.P.1992Aortic ValveBioprosthesisBlood PressureBody Surface AreaclassificationEvaluation Studies as TopicExerciseHeart Valve ProsthesisHemodynamicsHumansMitral ValvephysiologyProsthesis FailurestandardsStroke VolumesurgeryNot in FileS34S37Eur J Cardiothorac.Surg6 Suppl 1
Quebec Heart Institute, Laval University, Canada
PM:1389276Eur J Cardiothorac.Surg1Pibarot199671The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical statusJournal71The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical statusPibarot,P.Honos,G.N.Durand,L.G.Dumesnil,J.G.1996adverse effectsAngina PectorisAortic ValveBioprosthesisBody Surface AreaEchocardiography,DoppleretiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHemodynamic ProcessesHumansMalephysiologyPrognosisProspective StudiesProsthesis FailurePulmonary EdemaResearch Support,Non-U.S.Gov'tstandardsSyncopeNot in File379387Can.J.Cardiol.12
Institue de recherches cliniques de Montreal, Quebec. pibarop@ircm.umontreal.ca
PM:8608457Can.J.Cardiol.1Pibarot199865Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valveJournal65Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valvePibarot,P.Dumesnil,J.G.Lemieux,M.Cartier,P.Metras,J.Durand,L.G.1998adverse effectsAgedAortic ValveBioprosthesisBody Surface AreaCardiac OutputCohort StudiesComparative StudydiagnosisDisease-Free SurvivalEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHemodynamic ProcessesHumansMaleMiddle AgedmortalityphysiologyphysiopathologyPrognosisProspective StudiesProsthesis FailureProsthesis FittingResearch Support,Non-U.S.Gov'tsurgeryultrasonographyNot in File211218J.Heart Valve Dis.7
Department of Cardiology, Quebec Heart Institute, Ste Foy, Canada
PM:9587864J.Heart Valve Dis.1(1-3;7). Larger patients may be predisposed to mismatch because they have high cardiac output requirements, and greater narrowing of their valvular annulus in relation to their body size, compared to smaller patients  ADDIN REFMGR.CITE Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1(9). The incidence of mismatch has been demonstrated to increase with decreasing prosthesis size, and patients given valves d"21 mm tend to show higher transvalvular gradients  ADDIN REFMGR.CITE <Refman><Cite><Author>Milano</Author><Year>2002</Year><RecNum>2</RecNum><IDText>Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-upJournal2Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-upMilano,A.D.De,Carlo M.Mecozzi,G.D'Alfonso,A.Scioti,G.Nardi,C.Bortolotti,U.2002adverse effectsAgedAortic ValveAortic Valve StenosisBody Surface AreaComparative StudyEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedmortalityMultivariate AnalysisProportional Hazards ModelsProsthesis DesignsurgeryTreatment OutcomeultrasonographyNot in File3743Ann.Thorac.Surg.73
Divisions of Cardiac Surgery and Cardiology, Cardio-Thoracic Department University of Pisa Medical School, Italy
PM:11834061Ann.Thorac.Surg.1Bojar199347Clinical and hemodynamic performance of the 19-mm Carpentier-Edwards porcine bioprosthesisJournal47Clinical and hemodynamic performance of the 19-mm Carpentier-Edwards porcine bioprosthesisBojar,R.M.Rastegar,H.Payne,D.D.Mack,C.A.Schwartz,S.L.1993AdultAgedAged,80 and overAortic ValveBioprosthesisBody Surface AreaEchocardiographyEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHemodynamicsHospital MortalityHumansMaleMiddle AgedMorbiditymortalityphysiologyPostoperative CarePostoperative ComplicationsRetrospective StudiessurgerySurvival RateTime FactorsultrasonographyNot in File11411147Ann.Thorac Surg56
Department of Surgery (Cardiothoracic), New England Medical Center, Boston, MA 02111
PM:8239812Ann.Thorac Surg1(14;15). It must however be emphasized that severe mismatch may occur in patients receiving a prosthesis >21 mm  ADDIN REFMGR.CITE Pibarot199671The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical statusJournal71The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical statusPibarot,P.Honos,G.N.Durand,L.G.Dumesnil,J.G.1996adverse effectsAngina PectorisAortic ValveBioprosthesisBody Surface AreaEchocardiography,DoppleretiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHemodynamic ProcessesHumansMalephysiologyPrognosisProspective StudiesProsthesis FailurePulmonary EdemaResearch Support,Non-U.S.Gov'tstandardsSyncopeNot in File379387Can.J.Cardiol.12
Institue de recherches cliniques de Montreal, Quebec. pibarop@ircm.umontreal.ca
PM:8608457Can.J.Cardiol.1Pibarot199865Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valveJournal65Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valvePibarot,P.Dumesnil,J.G.Lemieux,M.Cartier,P.Metras,J.Durand,L.G.1998adverse effectsAgedAortic ValveBioprosthesisBody Surface AreaCardiac OutputCohort StudiesComparative StudydiagnosisDisease-Free SurvivalEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHemodynamic ProcessesHumansMaleMiddle AgedmortalityphysiologyphysiopathologyPrognosisProspective StudiesProsthesis FailureProsthesis FittingResearch Support,Non-U.S.Gov'tsurgeryultrasonographyNot in File211218J.Heart Valve Dis.7
Department of Cardiology, Quebec Heart Institute, Ste Foy, Canada
PM:9587864J.Heart Valve Dis.1(3;7). Mismatch occurs more frequently in patients with stenotic native valves as they generally have smaller valvular annuli than those with regurgitant valves  ADDIN REFMGR.CITE Pantely197848Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and in aortic incompetenceJournal48Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume, and performance in aortic stenosis and in aortic incompetencePantely,G.Morton,M.Rahimtoola,S.H.1978AdultAgedAortic Valve InsufficiencyAortic Valve StenosisCardiac OutputCardiac VolumeCardiomegalyFemaleHeart CatheterizationHeart Valve ProsthesisHumansMaleMiddle AgedMyocardial ContractionphysiopathologysurgeryNot in File383391J Thorac Cardiovasc Surg75PM:147370J Thorac Cardiovasc Surg1(16). Furthermore, calcific aortic stenosis is by far the most prevalent lesion in older patients undergoing aortic valve replacement (AVR). 1.4 Hemodynamic impact of prosthesis-patient mismatch The main consequence of prosthesispatient mismatch is the generation of a high transvalvular gradient through a normally functioning prosthetic valve. Assuming a normal cardiac index of 3 l/min/m2, implantation of a prosthesis with an EOA of 1.3 cm2 in a patient with a BSA of 1.5 m2 will theoretically result in a mean transprosthetic gradient (TPG) of about 13 mmHg. The mean TPG would theoretically be 35 mm Hg if the same prosthesis were to be implanted in a patient with a BSA of 2.5 m2  ADDIN REFMGR.CITE Pibarot200613Prosthesis-patient mismatch: definition, clinical impact, and preventionJournal13Prosthesis-patient mismatch: definition, clinical impact, and preventionPibarot,P.Dumesnil,J.G.2006Aortic ValveBlood Loss,SurgicalBody SizeetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansmortalityPostoperative ComplicationsProsthesis DesignProsthesis FittingResearch Support,Non-U.S.Gov'tRisk FactorssurgeryTreatment OutcomeVentricular Dysfunction,LeftNot in File10221029Heart92
Research Group in Valvular Heart Disease, Laval Hospital Research Centre/Quebec Heart Institute, Laval University, Sainte-Foy, Quebec, Canada. philippe.pibarot@med.ulaval.ca
PM:16251232Heart1(10). The increased transvalvular gradient associated with PPM has been shown to result in an increased left ventricular (LV) work, which in turn influenced the regression of LV hypertrophy (LVH)  ADDIN REFMGR.CITE Pibarot199957Changes in left ventricular mass and function after aortic valve replacement: a comparison between stentless and stented bioprosthetic valvesJournal57Changes in left ventricular mass and function after aortic valve replacement: a comparison between stentless and stented bioprosthetic valvesPibarot,P.Dumesnil,J.G.Leblanc,M.H.Cartier,P.Metras,J.1999AgedAnalysis of VarianceAortic ValveAortic Valve StenosisBioprosthesisBlood Flow VelocityChi-Square DistributionComparative StudyEchocardiography,DopplerFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansHypertrophy,Left VentricularMalephysiopathologyPrognosisResearch Support,Non-U.S.Gov'tStentssurgeryTreatment OutcomeultrasonographyNot in File981987J.Am.Soc.Echocardiogr.12
Quebec Heart Institute/Laval Hospital, Department of Medicine, Laval University, Ste-Foy, Quebec, Canada. philippe.pibarot@med.ulaval.ca
PM:10552360J.Am.Soc.Echocardiogr.1Tasca2005308Impact of the improvement of valve area achieved with aortic valve replacement on the regression of left ventricular hypertrophy in patients with pure aortic stenosisJournal308Impact of the improvement of valve area achieved with aortic valve replacement on the regression of left ventricular hypertrophy in patients with pure aortic stenosisTasca,G.Brunelli,F.Cirillo,M.Dalla,Tomba M.Mhagna,Z.Troise,G.Quaini,E.2005AgedAortic ValveAortic Valve StenosisEchocardiography,DopplerFemaleHeart Valve Prosthesis ImplantationHumansHypertrophy,Left VentricularMaleMiddle AgedMultivariate AnalysispathologyphysiopathologysurgeryVentricular Function,LeftNot in File12911296Ann.Thorac.Surg.79
Department of Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy. cch-segreteria.poli@poliambulanza.it
PM:15797064Ann.Thorac.Surg.1Tasca2005309Impact of valve prosthesis-patient mismatch on left ventricular mass regression following aortic valve replacementJournal309Impact of valve prosthesis-patient mismatch on left ventricular mass regression following aortic valve replacementTasca,G.Brunelli,F.Cirillo,M.DallaTomba,M.Mhagna,Z.Troise,G.Quaini,E.2005adverse effectsAgedAortic ValveAortic Valve StenosisBioprosthesisEchocardiography,DoppleretiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart VentriclesHumansHypertrophy,Left VentricularMaleMultivariate AnalysisPreoperative CareProsthesis FittingsurgeryultrasonographyNot in File505510Ann.Thorac.Surg.79
Department of Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy. cch-segreteria.poli@poliambulanza.it
PM:15680824Ann.Thorac.Surg.1Del Rizzo19998Factors affecting left ventricular mass regression after aortic valve replacement with stentless valvesJournal8Factors affecting left ventricular mass regression after aortic valve replacement with stentless valvesDel Rizzo,D.F.Abdoh,A.Cartier,P.Doty,D.Westaby,S.1999AgedAortic ValveBioprosthesisFemaleFollow-Up StudiesHeart Valve ProsthesisHeart VentriclesHumansMalepathologyProsthesis DesignResearch Support,Non-U.S.Gov'tsurgeryTime FactorsultrasonographyNot in File114120Semin.Thorac.Cardiovasc.Surg.11
University of Manitoba, Winnipeg, Canada
PM:10660178Semin.Thorac.Cardiovasc.Surg.1(17-20). LVH is in turn a strong independent risk factor for mortality as well as a major determinant of systolic and diastolic function and exercise capacity in patients undergoing valve replacement  ADDIN REFMGR.CITE Mehta200118Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgeryJournal18Implications of increased left ventricular mass index on in-hospital outcomes in patients undergoing aortic valve surgeryMehta,R.H.Bruckman,D.Das,S.Tsai,T.Russman,P.Karavite,D.Monaghan,H.Sonnad,S.Shea,M.J.Eagle,K.A.Deeb,G.M.2001Aortic ValveCardiac Output,LowComorbiditycomplicationsEchocardiographyepidemiologyFemaleHeart Valve Prosthesis ImplantationHospital MortalityHumansHypertrophy,Left VentricularLength of StayLogistic ModelsMalemethodsMiddle AgedmortalityMultivariate AnalysisPostoperative Complicationsstatistics & numerical datasurgeryTreatment OutcomeNot in File919928J Thorac Cardiovasc Surg122
Division of Cardiology and Section of Adult Cardiac Surgery, Heart Care Program, University of Michigan, Ann Arbor, MI48109-0348, USA
PM:11689797J Thorac Cardiovasc Surg1Duncan200819Influence of concentric left ventricular remodeling on early mortality after aortic valve replacementJournal19Influence of concentric left ventricular remodeling on early mortality after aortic valve replacementDuncan,A.I.Lowe,B.S.Garcia,M.J.Xu,M.Gillinov,A.M.Mihaljevic,T.Koch,C.G.2008AgedAortic ValveAortic Valve StenosisCardiac Output,LowCause of DeathEchocardiographyEchocardiography,Doppler,ColorFemaleHeart Valve Prosthesis ImplantationHospital MortalityHumansHypertrophy,Left VentricularMalemethodsMiddle AgedmortalityMyocardial InfarctionphysiologyPostoperative ComplicationsPrognosisRisk FactorssurgeryultrasonographyVentricular RemodelingNot in File20302039Ann.Thorac Surg85
Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. duncana@ccf.org
PM:18498815Ann.Thorac Surg1(21;22). Normalization of LV mass is therefore a crucial goal of AVR. The persistence of LVH associated with PPM has been proposed to be one of the factors contributing to adverse outcomes related to PPM. However, Sharma et al.  ADDIN REFMGR.CITE Sharma20042Systematic review of the outcome of aortic valve replacement in patients with aortic stenosisJournal2Systematic review of the outcome of aortic valve replacement in patients with aortic stenosisSharma,U.C.Barenbrug,P.Pokharel,S.Dassen,W.R.Pinto,Y.M.Maessen,J.G.2004AdultAgedanalysisAortic ValveAortic Valve StenosiscomplicationsepidemiologyetiologyEvidence-Based MedicineFemaleFollow-Up StudiesHeart Valve Prosthesis ImplantationHeart VentriclesHumansHypertrophy,Left VentricularMaleMiddle AgedNetherlandsOrgan SizepathologyPostoperative Complicationsstatistics & numerical dataStroke VolumesurgeryTreatment OutcomeVentricular Dysfunction,LeftNot in File9095Ann.Thorac Surg78
Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, University Hospital Maastricht, The Netherlands
PM:15223410Ann.Thorac Surg1(23) reviewed the published literature on LV mass regression (LVMR) after valve replacement for aortic stenosis over the past 23 years. They found that surgical correction of stenosis by valve replacement led to unequivocal regression of LV mass regardless of the type of valve inserted with the bulk of the hypertrophy regressing within the first 6 months of operation. These findings are supported by more recent publications also demonstrating that the extent of LVMR is maximal during the first 6 postoperative months and influenced only by the preoperative degree of hypertrophy and the presence of hypertension  ADDIN REFMGR.CITE Gaudino2004106Left ventricular mass regression after aortic valve replacement for aortic stenosis: time course and determinantsJournal106Left ventricular mass regression after aortic valve replacement for aortic stenosis: time course and determinantsGaudino,M.Glieca,F.Luciani,N.Cellini,C.Morelli,M.Girola,F.Guarini,G.Possati,G.2004AgedAortic ValveAortic Valve StenosisBioprosthesisFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHeart VentriclesHumansHypertrophy,Left VentricularMaleMiddle AgedpathologyphysiopathologyRemission InductionStroke VolumesurgeryTime FactorsultrasonographyNot in FileS55S58J Heart Valve Dis.13 Suppl 1
Department of Cardiac Surgery, Catholic University, Rome, Italy. mgaudino@tiscali.it
PM:15225004J Heart Valve Dis.1(24). In other studies, neither prosthesis size nor type was correlated with LVMR  ADDIN REFMGR.CITE Zeitani2004108Influence of patient-prosthesis mismatch on myocardial mass regression and clinical outcome in physically active patients after aortic valve replacementJournal108Influence of patient-prosthesis mismatch on myocardial mass regression and clinical outcome in physically active patients after aortic valve replacementZeitani,J.Bertoldo,F.Nardi,P.Iaci,G.Polisca,P.De,Paulis R.de Peppo,A.P.Chiariello,L.2004Actuarial AnalysisAdultAortic ValveAortic Valve StenosisBody Surface AreaFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHeart VentriclesHumansHypertrophy,Left VentricularMaleMiddle AgedpathologyphysiopathologyProsthesis DesignProsthesis FailureRemission InductionsurgerySurvival AnalysisultrasonographyNot in FileS63S67J Heart Valve Dis.13 Suppl 1
Division of Cardiac Surgery, Tor Vergata University of Rome, Italy. zeitani@hotmail.com
PM:15225006J Heart Valve Dis.1Knez20014Left ventricular architecture after valve replacement due to critical aortic stenosis: an approach to dis-/qualify the myth of valve prosthesis-patient mismatch?Journal4Left ventricular architecture after valve replacement due to critical aortic stenosis: an approach to dis-/qualify the myth of valve prosthesis-patient mismatch?Knez,I.Rienmuller,R.Maier,R.Rehak,P.Schrottner,B.Machler,H.nelli-Monti,M.Rigler,B.2001Agedanatomy & histologyAortic ValveAortic Valve StenosisBody Surface AreaCardiac OutputEchocardiographyFemaleHeart Valve ProsthesisHeart VentriclesHumansHypertrophyMalemethodsModels,TheoreticalpathologyphysiologyProspective StudiesResearch Support,Non-U.S.Gov'tsurgeryTimeVentricular Function,LeftNot in File797805Eur.J.Cardiothorac.Surg.19
Division of Cardiac Surgery, Karl Franzens University and Medical School of Graz, Graz, Austria. igor.knez@kfunigraz.ac.at
PM:11404133Eur.J.Cardiothorac.Surg.1(25;26). One explanation of the conflicting resluts related to LVMR and PPM may be that many studies showing long-term detrimental effects of LVH have been conducted in patients with hypertensive and ischemic heart disease  ADDIN REFMGR.CITE Levy199038Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart StudyJournal38Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart StudyLevy,D.Garrison,R.J.Savage,D.D.Kannel,W.B.Castelli,W.P.1990adverse effectsbloodBlood PressureCardiomegalyDiabetes ComplicationsdiagnosisEchocardiographyFemaleFollow-Up StudiesHumansLipidsMaleMiddle AgedmortalityMultivariate AnalysisPrognosisRisk FactorsSmokingNot in File15611566N Engl J Med322
Framingham Heart Study, Mass. 01701
PM:2139921The New England Journal of MedicineN Engl J Med1Verma2008111Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic StudyJournal111Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic StudyVerma,A.Meris,A.Skali,H.Ghali,J.K.Arnold,J.M.Bourgoun,M.Velazquez,E.J.McMurray,J.J.Kober,L.Pfeffer,M.A.Califf,R.M.Solomon,S.D.2008Agedanalogs & derivativesAngiotensin II Type 1 Receptor BlockersCardiovascular Diseasescomplicationsdrug therapyetiologyEuropeFemaleHeartHeart FailureHeart VentriclesHumansHypertrophy,Left VentricularKaplan-Meiers EstimateMalemethodsMiddle AgedMorbiditymortalityMyocardial InfarctionphysiopathologyPredictive Value of Testsprevention & controlProportional Hazards ModelsRecurrenceRiskRisk AssessmentRisk FactorsTetrazolestherapeutic useTime FactorsTreatment OutcomeultrasonographyUnited StatesValineVentricular RemodelingNot in File582591JACC.Cardiovasc Imaging1
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
PM:19356485JACC.Cardiovasc Imaging1(27;28). It remains to be seen whether similar consequences are observed with respect to the hypertrophy due to valvular disease. The difference in TPG between patients with PPM and those without may be even more important during exercise, given that gradients are a square function of flow. Recently, Bleiziffer et al.  ADDIN REFMGR.CITE Bleiziffer200812Impact of patient-prosthesis mismatch on exercise capacity in patients after bioprosthetic aortic valve replacementJournal12Impact of patient-prosthesis mismatch on exercise capacity in patients after bioprosthetic aortic valve replacementBleiziffer,S.Eichinger,W.B.Hettich,I.Ruzicka,D.Wottke,M.Bauernschmitt,R.Lange,R.2008adverse effectsAgedAortic ValveBioprosthesisBody Surface AreaEchocardiographyEchocardiography,DopplerEpidemiologic MethodsExerciseExercise TestExercise ToleranceFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamicsHumansMalemethodsmortalityphysiologyphysiopathologyPostoperative ComplicationsPostoperative Periodprevention & controlsurgeryTreatment OutcomeultrasonographyNot in File637641Heart94
Clinic for Cardiovascular Surgery, German Heart Center Munich, Lazarettstrasse, 36, 80636 Munich, Germany. bleiziffer@dhm.mhn.de
PM:17686803Heart1(29) were the first to report that the presence of PPM significantly influenced the peak physical exercise capacity, according to stress test echocardiography, following AVR. The authors suggested that their findings could be explained by an increase in hemodynamic burden resulting from higher gradients in patients with PPM. Another possible explanation is that PPM may limit the increase in cardiac output during exercise, similar to that observed in native aortic stenosis. This may in turn limit the capacity of the cardiac function to match the increasing metabolic demand during intense exercise. Mannacio et al.  ADDIN REFMGR.CITE Mannacio200988Influence of prosthesis-patient mismatch on exercise-induced arrhythmias: A further aspect after aortic valve replacementJournal88Influence of prosthesis-patient mismatch on exercise-induced arrhythmias: A further aspect after aortic valve replacementMannacio,Vito AntonioDe,Amicis,VDi,Tommaso LuigiIorio,FrancescoVosa,Carlo2009Aortic ValveExerciseFemalemethodsMorbiditymortalityMultivariate AnalysisNot in File632638The Journal of Thoracic and Cardiovascular Surgery13800225223The Journal of Thoracic and Cardiovascular Surgery1(30) evaluated the impact of PPM defined as EOAi<0.75 cm2/m2 on exercise capacity and arrhythmias. The authors demonstrated that high mean TPG (above 50 mmHg) during exercise had 95% sensitivity and 72% specificity for predicting arrhythmia. However, PPM failed to demonstrate any significant correlation to early or late mortality, morbidity, or LVMR. In contrast, Izzat et al.  ADDIN REFMGR.CITE Izzat1999105Patient-prosthesis mismatch is negligible with modern small-size aortic valve prosthesesJournal105Patient-prosthesis mismatch is negligible with modern small-size aortic valve prosthesesIzzat,M.B.Kadir,I.Reeves,B.Wilde,P.Bryan,A.J.Angelini,G.D.1999Aortic ValveBody Surface AreaDobutamineNot in File16571660Ann Thorac Surg6800034975The Annals of Thoracic SurgeryAnn Thorac Surg1(31) examined a series of patients with modern, small aortic valve prostheses examined at rest and during dobutamine-stress testing. They found that the main predictor of a high transprosthetic gradient was related to the inherent characteristics of each prosthesis, while variations in BSA had only a relatively insignificant effect. They concluded that PPM is not a problem of clinical significance when using certain modern valve prostheses. The development of LVH in aortic stenosis is accompanied by coronary microcirculatory dysfunction, demonstrated by an impaired coronary flow reserve (CFR)  ADDIN REFMGR.CITE Rajappan200221Mechanisms of Coronary Microcirculatory Dysfunction in Patients With Aortic Stenosis and Angiographically Normal Coronary ArteriesJournal21Mechanisms of Coronary Microcirculatory Dysfunction in Patients With Aortic Stenosis and Angiographically Normal Coronary ArteriesRajappan,KimRimoldi,Ornella E.Dutka,David P.Ariff,BenPennell,Dudley J.Sheridan,Desmond J.Camici,Paolo G.2002Aortic ValveEchocardiographymethodsNot in File470476Circulation105http://circ.ahajournals.org/cgi/content/abstract/105/4/470Circulation1(32). CFR in turn, is related to the native aortic valve area and the peak transvalvular gradients rather than the degree of LVH  ADDIN REFMGR.CITE Rajappan20034Functional Changes in Coronary Microcirculation After Valve Replacement in Patients With Aortic StenosisJournal4Functional Changes in Coronary Microcirculation After Valve Replacement in Patients With Aortic StenosisRajappan,KimRimoldi,Ornella E.Camici,Paolo G.Bellenger,Nicholas G.Pennell,Dudley J.Sheridan,Desmond J.2003Aortic ValveNot in File31703175Circulation107http://circ.ahajournals.org/cgi/content/abstract/107/25/3170Circulation1(33). In theory, inadequate valve opening or residual transprosthetic gradients will cause turbulent aortic root flow, and may thus also impair physiological backflow during diastole with subsequent impairment of CFR. Bakhtiary et al.  ADDIN REFMGR.CITE Bakhtiary200720Impact of patient-prosthesis mismatch and aortic valve design on coronary flow reserve after aortic valve replacementJournal20Impact of patient-prosthesis mismatch and aortic valve design on coronary flow reserve after aortic valve replacementBakhtiary,F.Schiemann,M.Dzemali,O.Dogan,S.Schachinger,V.Ackermann,H.Moritz,A.Kleine,P.2007AgedAortic ValveAortic Valve StenosisBioprosthesisBlood PressureCoronary CirculationEchocardiographyFemaleHeart RateHeart Valve ProsthesisHeart VentriclesHumansMalemethodsMiddle AgedmortalityOrgan SizepathologyProspective StudiesProsthesis DesignProsthesis FailureProsthesis FittingsurgeryTreatment OutcomeultrasonographyNot in File790796J Am.Coll.Cardiol.49
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany. farhad@bakhtiary.de
PM:17306709J Am.Coll.Cardiol.1(34) studied the role of PPM on coronary perfusion and found that patients with PPM demonstrated less improvement in CFR than those without. However, the CFR improved for all valve types studied with complete normalization of CFR following implantation of a stentless valve. The authors stated that they could not prove any clinical relevance of an impaired CFR on long-term outcome, and concluded that the flow through the valve prostheses analyzed may be adequate. Patients with LV dysfunction and low-flow, low-gradient (LFLG) aortic stenosis represent 5% to 10% of patients with aortic stenosis. They also represent the most challenging and controversial subset of aortic stenosis patients with regard to management  ADDIN REFMGR.CITE Blais200641Projected Valve Area at Normal Flow Rate Improves the Assessment of Stenosis Severity in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The Multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) StudyJournal41Projected Valve Area at Normal Flow Rate Improves the Assessment of Stenosis Severity in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The Multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) StudyBlais,ClaudiaBurwash,Ian G.Mundigler,GeraldDumesnil,Jean G.Loho,NicoleRader,FlorianBaumgartner,HelmutBeanlands,Rob S.Chayer,BorisKadem,LyesGarcia,DamienDurand,Louis GillesPibarot,Philippe2006Aortic ValveclassificationEchocardiographymethodssurgeryNot in File711721Circulation113http://circ.ahajournals.org/cgi/content/abstract/113/5/711Circulation1(35). Dobutamine stress echocardiography has been shown to be useful in differentiating patients with truly severe aortic stenosis and concomitant LV systolic dysfunction from those with pseudo-severe aortic stenosis, in which a weakened ventricle is incapable of opening an aortic valve that is only mildly or moderately stenotic  ADDIN REFMGR.CITE Monin200342Low-Gradient Aortic Stenosis: Operative Risk Stratification and Predictors for Long-Term Outcome: A Multicenter Study Using Dobutamine Stress HemodynamicsJournal42Low-Gradient Aortic Stenosis: Operative Risk Stratification and Predictors for Long-Term Outcome: A Multicenter Study Using Dobutamine Stress HemodynamicsMonin,Jean LucQuere,Jean PaulMonchi,MehranPetit,HeleneBaleynaud,SergeChauvel,ChristophePop,CameliaOhlmann,PatrickLelguen,ClaudeDehant,PatrickTribouilloy,ChristopheGueret,Pascal2003Aortic ValveHemodynamicsmethodsmortalitysurgeryNot in File319324Circulation108http://circ.ahajournals.org/cgi/content/abstract/108/3/319Circulation1Blais200641Projected Valve Area at Normal Flow Rate Improves the Assessment of Stenosis Severity in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The Multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) StudyJournal41Projected Valve Area at Normal Flow Rate Improves the Assessment of Stenosis Severity in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The Multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) StudyBlais,ClaudiaBurwash,Ian G.Mundigler,GeraldDumesnil,Jean G.Loho,NicoleRader,FlorianBaumgartner,HelmutBeanlands,Rob S.Chayer,BorisKadem,LyesGarcia,DamienDurand,Louis GillesPibarot,Philippe2006Aortic ValveclassificationEchocardiographymethodssurgeryNot in File711721Circulation113http://circ.ahajournals.org/cgi/content/abstract/113/5/711Circulation1(35;36). It is essential to make the distinction between these two subgroups because patients with truly severe aortic stenosis will generally benefit from AVR, whereas those with pseudo-severe AS may not. This latter group of patients generally has a poor prognosis with conservative therapy but a high operative mortality when treated surgically  ADDIN REFMGR.CITE Monin200342Low-Gradient Aortic Stenosis: Operative Risk Stratification and Predictors for Long-Term Outcome: A Multicenter Study Using Dobutamine Stress HemodynamicsJournal42Low-Gradient Aortic Stenosis: Operative Risk Stratification and Predictors for Long-Term Outcome: A Multicenter Study Using Dobutamine Stress HemodynamicsMonin,Jean LucQuere,Jean PaulMonchi,MehranPetit,HeleneBaleynaud,SergeChauvel,ChristophePop,CameliaOhlmann,PatrickLelguen,ClaudeDehant,PatrickTribouilloy,ChristopheGueret,Pascal2003Aortic ValveHemodynamicsmethodsmortalitysurgeryNot in File319324Circulation108http://circ.ahajournals.org/cgi/content/abstract/108/3/319Circulation1Quere200643Influence of Preoperative Left Ventricular Contractile Reserve on Postoperative Ejection Fraction in Low-Gradient Aortic StenosisJournal43Influence of Preoperative Left Ventricular Contractile Reserve on Postoperative Ejection Fraction in Low-Gradient Aortic StenosisQuere,Jean PaulMonin,Jean LucLevy,FranckPetit,HeleneBaleynaud,SergeChauvel,ChristophePop,CameliaOhlmann,PatrickLelguen,ClaudeDehant,PatrickGueret,PascalTribouilloy,Christophe2006Aortic ValveHemodynamicsmethodsmortalitysurgeryNot in File17381744Circulation113http://circ.ahajournals.org/cgi/content/abstract/113/14/1738Circulation1(36;37). However, patients with LFLG aortic stenosis surviving AVR exhibit a significant improvement in LV ejection fraction (LVEF) and functional status and have an acceptable long-term survival  ADDIN REFMGR.CITE Quere200643Influence of Preoperative Left Ventricular Contractile Reserve on Postoperative Ejection Fraction in Low-Gradient Aortic StenosisJournal43Influence of Preoperative Left Ventricular Contractile Reserve on Postoperative Ejection Fraction in Low-Gradient Aortic StenosisQuere,Jean PaulMonin,Jean LucLevy,FranckPetit,HeleneBaleynaud,SergeChauvel,ChristophePop,CameliaOhlmann,PatrickLelguen,ClaudeDehant,PatrickGueret,PascalTribouilloy,Christophe2006Aortic ValveHemodynamicsmethodsmortalitysurgeryNot in File17381744Circulation113http://circ.ahajournals.org/cgi/content/abstract/113/14/1738Circulation1(37). It has been suggested that the impact of PPM on postoperative mortality depends on the severity of mismatch and the degree of preoperative LV dysfunction  ADDIN REFMGR.CITE Pibarot200966Prosthetic heart valves: selection of the optimal prosthesis and long-term managementJournal66Prosthetic heart valves: selection of the optimal prosthesis and long-term managementPibarot,P.Dumesnil,J.G.2009Not in File10341048Circulation119
Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V-4G5. philippe.pibarot@med.ulaval.ca or medjgd@hermes.ulaval.ca
PM:19237674Circulation1Urso200930Is patient-prosthesis mismatch an independent risk factor for early and mid-term mortality in adult patients undergoing aortic valve replacement?Journal30Is patient-prosthesis mismatch an independent risk factor for early and mid-term mortality in adult patients undergoing aortic valve replacement?Urso,S.Sadaba,J.R.miz-Echevarria,G.2009AdultAortic ValveHeart Valve ProsthesismortalitysurgeryNot in FileInteract Cardiovasc Thorac Surg
Clinica Capio, Albacete, Spain
PM:19497953Interactive CardioVascular and Thoracic SurgeryInteract Cardiovasc Thorac Surg1(38;39). If this is indeed the case, PPM should theoretically have a major impact on patients with LFLG aortic stenosis following AVR. The greatest impact should be on mortality during the early postoperative period when the LV is most vulnerable  ADDIN REFMGR.CITE Blais20033Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementJournal3Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementBlais,C.Dumesnil,J.G.Baillot,R.Simard,S.Doyle,D.Pibarot,P.2003adverse effectsAgedAortic ValveBody SizeCohort StudiesepidemiologyFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansIntraoperative PeriodMalemortalityMultivariate AnalysisOdds RatioOutcome Assessment (Health Care)physiopathologyPostoperative PeriodProspective StudiesQuebecReference ValuesResearch Support,Non-U.S.Gov'tRisk AssessmentRisk Factorsstandardsstatistics & numerical dataStroke VolumesurgeryTimeVascular PatencyNot in File983988Circulation108
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada
PM:12912812Circulation1(12). Monin et al.  ADDIN REFMGR.CITE Monin200740Low-gradient aortic stenosis: impact of prosthesis-patient mismatch on survivalJournal40Low-gradient aortic stenosis: impact of prosthesis-patient mismatch on survivalMonin,JeanMonchi,MehranKirsch Matthias,E.W.Petit-Eisenmann,H.+Baleynaud,SergeChauvel,ChristopheMetz,DamienAdams,CatherineQuere,JeanGueret,PascalTribouilloy,Christophe2007methodsmortalitysurgeryNot in File26202626Eur Heart J280195668XEuropean Heart JournalEur Heart J1(40) reported postoperative outcomes in a large, multi-center study of consecutive series of patients who underwent AVR for LFLG aortic stenosis. They found that PPM (moderate in most cases) had no influence on early postoperative mortality, or on long-term postoperative outcome. The authors stated that the overall postoperative mortality was mainly influenced by the LV contractile reserve. They concluded that the performance of more complex interventions in an attempt to avoid moderate PPM may not be justified in patients with LFLG aortic stenosis. In another study, Kulik et al.  ADDIN REFMGR.CITE Kulik200644Long-Term Outcomes After Valve Replacement for Low-Gradient Aortic Stenosis: Impact of Prosthesis-Patient MismatchJournal44Long-Term Outcomes After Valve Replacement for Low-Gradient Aortic Stenosis: Impact of Prosthesis-Patient MismatchKulik,AlexanderBurwash,Ian G.Kapila,VarunMesana,Thierry G.Ruel,Marc2006Aortic ValveEchocardiographymethodsmortalityNot in FileI5538Circulation114http://circ.ahajournals.org/cgi/content/abstract/114/1_suppl/I-553Circulation1(41) reported that for patients with LFLG aortic stenosis, PPM following AVR resulted in an impaired LVMR, and that is was an independent predictor of recurrent episodes of heart failure. However, early mortality, and LV contractile reserve were not assessed in this study, which constitutes a major limitation. 1.5 The clinical influence of prosthesis-patient mismatch 1.5.1 Survival Bridges et al.  ADDIN REFMGR.CITE Bridges200765Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacementJournal65Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacementBridges,C.R.O'Brien,S.M.Cleveland,J.C.Savage,E.B.Gammie,J.S.Edwards,F.H.Peterson,E.D.Grover,F.L.2007AdultAgedAged,80 and overaortic valveAortic valve replacementBody Surface AreaFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansinstrumentationMalemethodsMiddle AgedmortalityProsthesis DesignsurgeryNot in File10121021J Thorac Cardiovasc Surg133
Department of Surgery, the University of Pennsylvania Health System, Philadelphia, Pa, USA. cbridges@pahosp.com
PM:17382644J Thorac Cardiovasc Surg1(42) have analyzed PPM in the hitherto largest sample (42,310 patients). Prostheses with small geometric orifice area (GOA) or EOA were reported to be associated with increased operative mortality. However, a higher BSA for a given EOA or GOA was found to be associated with lower operative mortality for patients receiving prostheses of the same model and size. Furthermore, EOAi and the indexed GOA were not significant predictors of operative mortality in their multivariable models. Based on these findings the authors concluded that the practice of using arbitrary cutoff values of EOAi as a decision tool to determine the type or size of valve to be utilized in a given patient, in an attempt to decrease operative mortality, was not advisable. The authors also concluded that in isolated AVR, priority should be given to prosthesis durability, the experience of the surgeon, and the technical ease and speed of implantation. Blackstone et al.  ADDIN REFMGR.CITE Blackstone200376Prosthesis size and long-term survival after aortic valve replacementJournal76Prosthesis size and long-term survival after aortic valve replacementBlackstone,E.H.Cosgrove,D.M.Jamieson,W.R.Birkmeyer,N.J.Lemmer,J.H.,Jr.Miller,D.C.Butchart,E.G.Rizzoli,G.Yacoub,M.Chai,A.2003AgedAlgorithmsAortic ValveBioprosthesisBody Surface AreaFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityProsthesis Designstatistics & numerical datasurgerySurvival RateTime FactorsNot in File783796J.Thorac.Cardiovasc.Surg.126
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA. blackse@ccf.org
PM:14502155J.Thorac.Cardiovasc.Surg.1(43) found a small increase in 30-day mortality (12%) for patients with an indexed GOA<1.2 cm2/m2. They were unable to identify PPM as a risk factor for late survival. The authors acknowledged that reduced survival following AVR is related to many factors with the potential to mask the impact of PPM on late mortality. They concluded that with currently available prostheses, few patients should require aortic root enlargement with its attendant complexity, prolonged operation time, risks of bleeding, heart block, and mortality, particularly if a bioprosthesis is used  ADDIN REFMGR.CITE Sommers1997337Aortic valve replacement with patch enlargement of the aortic annulusJournal337Aortic valve replacement with patch enlargement of the aortic annulusSommers,K.E.David,T.E.1997AgedAnimalsAortic ValveAortic valve replacementBioprosthesisCase-Control StudiesCattleChi-Square DistributionEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHumansMalemethodsMiddle AgedmortalityPericardiumProportional Hazards ModelsRetrospective StudiessurgerySurvival RatetransplantationTransplantation,HeterologousultrasonographyNot in File16081612Ann Thorac Surg63
Division of Cardiovascular Surgery, The Toronto Hospital and the University of Toronto, Ontario, Canada
PM:9205157The Annals of Thoracic SurgeryAnn Thorac Surg1(44). In a study by Hanayama et al.  ADDIN REFMGR.CITE Hanayama200214Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantJournal14Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantHanayama,N.Christakis,G.T.Mallidi,H.R.Joyner,C.D.Fremes,S.E.Morgan,C.D.Mitoff,P.R.Goldman,B.S.2002AdultAgedAnthropometryAortic ValveepidemiologyetiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedPostoperative ComplicationsPrevalenceProspective StudiesProsthesis Designstatistics & numerical datasurgerySurvival RateNot in File18221829Ann.Thorac.Surg.73
Division of Cardiovascular Surgery of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
PM:12078776file://H:\Dokument\Publications on PPM\HanayamaPPM is rare after AVR.pdfAnn.Thorac.Surg.1(45) on 1129 patients who had undergone AVR and postoperative echocardiographic assessment of the prosthetic valve with in vivo EOA, severe mismatch (EOAi<0.60 cm2/m2) had no effect on survival up to 7 years after surgery. Furthermore, severe PPM had no impact on LVMR or deteriorating NYHA-class. The estimated 7-year survival rate of patients with severe mismatch was 95%. However, the mean age of the patients with PPM was 62 years at the time of surgery and the study population was heterogeneous, including patients with aortic insufficiency and patients undergoing double valve replacement and root procedures. Blais et al. ADDIN REFMGR.CITE Blais20033Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementJournal3Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementBlais,C.Dumesnil,J.G.Baillot,R.Simard,S.Doyle,D.Pibarot,P.2003adverse effectsAgedAortic ValveBody SizeCohort StudiesepidemiologyFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansIntraoperative PeriodMalemortalityMultivariate AnalysisOdds RatioOutcome Assessment (Health Care)physiopathologyPostoperative PeriodProspective StudiesQuebecReference ValuesResearch Support,Non-U.S.Gov'tRisk AssessmentRisk Factorsstandardsstatistics & numerical dataStroke VolumesurgeryTimeVascular PatencyNot in File983988Circulation108
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada
PM:12912812Circulation1(12) demonstrated that both severe and moderate PPM were independent predictors of early mortality and that the impact of PPM is dependent on both its degree of severity and the LV function. However, the authors acknowledge that there were limitations in their study in terms of differences in baseline patient characteristics. Co-morbidity factors such as older age, female gender, coronary artery disease, hypertension, diabetes mellitus, and emergent/salvage operation were more prevalent in patients with moderate and severe PPM. The authors stated that it could not be completely excluded that these co-morbidities may have contributed to the higher mortality in patients with PPM. Independent detrimental effects of PPM were also observed by Ruel et al.  ADDIN REFMGR.CITE Ruel200618Prosthesis-patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: effect on survival, freedom from heart failure, and left ventricular mass regressionJournal18Prosthesis-patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: effect on survival, freedom from heart failure, and left ventricular mass regressionRuel,M.Al-Faleh,H.Kulik,A.Chan,K.L.Mesana,T.G.Burwash,I.G.2006/5Adultadverse effectsAgedAortic ValvecomplicationsetiologyFemaleHeart Failure,CongestiveHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansHypertrophy,Left VentricularMaleMiddle AgedProsthesis FailureRemission InductionsurgerySurvival AnalysisVentricular Dysfunction,LeftNot in File10361044J.Thorac.Cardiovasc.Surg.131
Division of Cardiac Surgery, University of Ottawa, Ottawa, Ontario, Canada. mruel@ottawaheart.ca
PM:16678587J.Thorac.Cardiovasc.Surg.1(46) although only for patients with impaired preoperative LV systolic function, in whom PPM was associated with decreased overall long-term survival, a higher degree of heart failure, and reduced LVMR at the time of AVR. Furthermore, Ruel and coworkers  ADDIN REFMGR.CITE Ruel20046Late incidence and predictors of persistent or recurrent heart failure in patients with aortic prosthetic valvesJournal6Late incidence and predictors of persistent or recurrent heart failure in patients with aortic prosthetic valvesRuel,M.Rubens,F.D.Masters,R.G.Pipe,A.L.Bedard,P.Hendry,P.J.Lam,B.K.Burwash,I.G.Goldstein,W.G.Brais,M.P.Keon,W.J.Mesana,T.G.2004Adultadverse effectsAge DistributionAgedAged,80 and overAortic ValveBioprosthesisBody Surface AreaCohort StudiesComparative StudydiagnosisEchocardiographyepidemiologyetiologyFemaleHeart Failure,CongestiveHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansIncidenceMalemethodsMiddle AgedMitral ValvemortalityPostoperative ComplicationsPredictive Value of TestsProportional Hazards ModelsProsthesis FailureRecurrenceRetrospective StudiesRisk FactorsSeverity of Illness IndexSex DistributionSmokingsurgerySurvival AnalysisTimeNot in File149159J.Thorac.Cardiovasc.Surg.127
Division of Cardiac Surgery, Department of Epidemiology, University of Ottawa, Ontario, Canada. mruel@ottawaheart.ca
PM:14752425J.Thorac.Cardiovasc.Surg.1(47) have previously studied risk factors for the composite outcome of heart failure symptoms and death from heart failure following AVR. Risk factors included smaller prostheses, higher postoperative TPGs, and PPM, defined as either EOAid"0.75 cm2/m2 or EOAid"0.80 cm2/m2. These findings suggest that an increased hemodynamic burden caused by PPM could be less well tolerated by a poorly functioning ventricle than by a normal ventricle. However, the classic definition of PPM, EOAid"0.85 cm2/m2, was not associated with an increased incidence of congestive heart failure, cardiac related death, their combined occurrence, or all-cause death in this study. The authors explained that despite all-cause mortality being a robust and easily interpretable end point, it is limited as a specific indicator by the plethora of confounding and contributing factors and by the availability of medical therapy for the palliation of mild to moderate heart failure. In an elderly patient population, competing causes of death such as coronary disease, valve-related complications, cancer, and others may also have influenced the effect of PPM on all-cause mortality following AVR. The impact of PPM on survival has been demonstrated to be more pronounced in young patients than older patients of average or large size  ADDIN REFMGR.CITE Moon2006331Prosthesis-Patient Mismatch After Aortic Valve Replacement: Impact of Age and Body Size on Late SurvivalJournal331Prosthesis-Patient Mismatch After Aortic Valve Replacement: Impact of Age and Body Size on Late SurvivalMoon,Marc R.Pasque,Michael K.Munfakh,Nabil A.Melby,Spencer J.Lawton,Jennifer S.Moazami,NaderCodd,John E.Crabtree,Traves D.Barner,Hendrick B.Damiano,Ralph J.,Jr.2006Aortic ValveAortic valve replacementBody SizeBody Surface AreamethodsNot in File481489Ann Thorac Surg81http://ats.ctsnetjournals.org/cgi/content/abstract/81/2/481The Annals of Thoracic SurgeryAnn Thorac Surg1Mohty20092Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionJournal2Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionMohty,DaniaDumesnil,Jean G.Echahidi,NajmeddineMathieu,PatrickDagenais,FrantoisVoisine,PierrePibarot,Philippe2009aortic valveheart valve prostheseshemodynamicsmortalityNot in File3947Journal of the American College of Cardiology530735-1097doi: DOI: 10.1016/j.jacc.2008.09.022http://www.sciencedirect.com/science/article/B6T18-4V8B39S-9/2/f7a66045e843a4c5dccfd4d747db2040Journal of the American College of Cardiology1(48;49). These findings may be related to the higher cardiac output requirements of younger patients. Younger patients may also be exposed to the risk of PPM for a longer period of time. Also, PPM has been reported to have a negative impact on late survival for patients 70 years of age or above  ADDIN REFMGR.CITE Moon20099POINT: Prosthesis-patient mismatch does not affect survival for patients greater than 70 years of age undergoing bioprosthetic aortic valve replacementJournal9POINT: Prosthesis-patient mismatch does not affect survival for patients greater than 70 years of age undergoing bioprosthetic aortic valve replacementMoon,Marc R.Lawton,Jennifer S.Moazami,NaderMunfakh,Nabil A.Pasque,Michael K.Damiano,Jr2009Aortic ValveNot in File278283The Journal of Thoracic and Cardiovascular Surgery1370022-5223doi: DOI: 10.1016/j.jtcvs.2008.09.059http://www.sciencedirect.com/science/article/B6WMF-4V5XPB5-J/2/c4978bac2859fc8000af6cdf2983ed4bThe Journal of Thoracic and Cardiovascular Surgery1(50). These findings may indicate that attention should be devoted to attempts to improve PPM in younger patients while adopting a less aggressive approach in small, elderly patients. Elderly patients may be better served with a simpler, faster procedure, based on the assumption that PPM does not have a significant impact on late survival  ADDIN REFMGR.CITE Hanayama200214Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantJournal14Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantHanayama,N.Christakis,G.T.Mallidi,H.R.Joyner,C.D.Fremes,S.E.Morgan,C.D.Mitoff,P.R.Goldman,B.S.2002AdultAgedAnthropometryAortic ValveepidemiologyetiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedPostoperative ComplicationsPrevalenceProspective StudiesProsthesis Designstatistics & numerical datasurgerySurvival RateNot in File18221829Ann.Thorac.Surg.73
Division of Cardiovascular Surgery of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
PM:12078776file://H:\Dokument\Publications on PPM\HanayamaPPM is rare after AVR.pdfAnn.Thorac.Surg.1(45). 1.5.2 Prosthesis-patient mismatch and morbidity Based on the assumption that the LV is most vulnerable during the early post-operative period  ADDIN REFMGR.CITE Gillies200584Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewJournal84Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewGillies,MichaelBellomo,RinaldoDoolan,LaurieBuxton,Brian2005AdultCardiac Outputdrug therapyHeartIncidencePressuresurgerySyndrometherapyNot in File266279Critical Care91364-853510.1186/cc3024Critical Care1(51) it is reasonale to assume that the increased afterload caused by PPM would be particularly deleterious, leading to excess morbidity during this period. Studies on the impact of PPM on postoperative complications, including cardiac complications, are, however, scarce. Yap et al.  ADDIN REFMGR.CITE Yap200726Prosthesis-patient mismatch is associated with higher operative mortality following aortic valve replacementJournal26Prosthesis-patient mismatch is associated with higher operative mortality following aortic valve replacementYap,C.H.Mohajeri,M.Yii,M.2007adverse effectsAge FactorsAgedAged,80 and overAnalysis of VarianceAortic ValveAortic Valve InsufficiencyAortic Valve StenosisAustraliabloodBody SizeCreatinineepidemiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHospital MortalityHumansLength of StayMalemethodsMiddle AgedmortalityPatient ReadmissionProspective StudiesProsthesis DesignProsthesis FailurePulmonary Wedge PressureSeverity of Illness IndexsurgeryTreatment OutcomeNot in File260264Heart Lung Circ.16
Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia. Cheng-Hon.YAP@svhm.org.au
PM:17442619Heart Lung Circ.1(52) found no association between severe PPM and early morbidity events including stroke, prolonged ventilation, new renal failure, prolonged postoperative stay, prolonged intensive care unit (ICU) stay, or readmission within 30 days. Despite the absence of a correlation to morbidity, PPM was found to be an independent predictor for increased 30-day mortality. The authors stated that their study may have lacked the power to detect differences in the rates of early morbidity. Further studies with larger patient populations experiencing more postoperative events are clearly warranted. Frapier et al.  ADDIN REFMGR.CITE Frapier2002323Influence of patient-prosthesis mismatch on long-term results after aortic valve replacement with a stented bioprosthesisJournal323Influence of patient-prosthesis mismatch on long-term results after aortic valve replacement with a stented bioprosthesisFrapier,J.M.Rouviere,P.Razcka,F.Aymard,T.Albat,B.Chaptal,P.A.2002Aortic ValveAortic valve replacementBioprosthesisNot in File543551Journal of Heart Valve Disease11http://www.sciencedirect.com/science/article/B6T1G-46HMDF6-2J0/2/5987277644a7399c909a5bf1505e233cJournal of Heart Valve Disease1(53) compared long-term results for morbidity following implantation of bioprostheses in the aortic position, in a small series of patients, with and without PPM. At 10 years postoperatively, there was no significant inter-group difference in actuarial freedom from thromboembolism, hemorrhage, endocarditis, structural valve deterioration or reoperation 1.5.3 Prosthesis-patient mismatch and BMI The use of the BSA to normalize the EOA may overestimate the prevalence and severity of PPM in obese patients  ADDIN REFMGR.CITE Mohty20092Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionJournal2Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionMohty,DaniaDumesnil,Jean G.Echahidi,NajmeddineMathieu,PatrickDagenais,FrantoisVoisine,PierrePibarot,Philippe2009aortic valveheart valve prostheseshemodynamicsmortalityNot in File3947Journal of the American College of Cardiology530735-1097doi: DOI: 10.1016/j.jacc.2008.09.022http://www.sciencedirect.com/science/article/B6T18-4V8B39S-9/2/f7a66045e843a4c5dccfd4d747db2040Journal of the American College of Cardiology1(49). The interaction between PPM and obesity was evaluated by Mohty et al.  ADDIN REFMGR.CITE Mohty20092Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionJournal2Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionMohty,DaniaDumesnil,Jean G.Echahidi,NajmeddineMathieu,PatrickDagenais,FrantoisVoisine,PierrePibarot,Philippe2009aortic valveheart valve prostheseshemodynamicsmortalityNot in File3947Journal of the American College of Cardiology530735-1097doi: DOI: 10.1016/j.jacc.2008.09.022http://www.sciencedirect.com/science/article/B6T18-4V8B39S-9/2/f7a66045e843a4c5dccfd4d747db2040Journal of the American College of Cardiology1(49) demonstrating that PPM has a negative impact on survival in patients with a BMI <30 kg/m2, but no significant impact in obese patients. It thus appears that obesity should be taken into account when assessing the risk of PPM. The investigators of the Strong Heart Study reported that fat-free mass, which represents the metabolically active tissues, accounts for 20% to 40% of the weight difference between lean and obese individuals of the same height  ADDIN REFMGR.CITE Collis200149Relations of stroke volume and cardiac output to body composition: the strong heart studyJournal49Relations of stroke volume and cardiac output to body composition: the strong heart studyCollis,T.Devereux,R.B.Roman,M.J.de,Simone G.Yeh,J.Howard,B.V.Fabsitz,R.R.Welty,T.K.2001Adipose TissueAgedAged,80 and overAnalysis of VarianceBody CompositionBody Mass IndexBody Surface AreaBody WaterBody WeightCardiac OutputCardiography,ImpedanceCardiovascular DiseasesDemographyEchocardiographyetiologyFemaleHumansIndians,North AmericanMaleMathematicsmethodsMiddle AgedObesitypathologyphysiologyphysiopathologyRisk FactorsSex FactorsStroke VolumeUnited StatesNot in File820825Circulation103
Cornell Medical Center, New York, NY, USA. rbdevere@med.cornell.edu
PM:11171789Circulation1(54). They also demonstrated that stroke volume and cardiac output are more strongly related to fat-free mass than to adipose mass. Hence, a potentially interesting design would be to normalize the EOA to the fat-free mass, since this parameter appears to be the main determinant of cardiac output in normal-weight, overweight, and obese people. Future studies will be necessary to determine if the indexation of EOA can be improved or refined in the case of obese patients. 1.5.4 Prosthesis-patient mismatch and in vivo EOA Prosthesis-patient mismatch can be predicted at the time of surgery by obtaining the EOA for the selected valve type from the literature; referred to as the projected EOA  ADDIN REFMGR.CITE Pibarot200966Prosthetic heart valves: selection of the optimal prosthesis and long-term managementJournal66Prosthetic heart valves: selection of the optimal prosthesis and long-term managementPibarot,P.Dumesnil,J.G.2009Not in File10341048Circulation119
Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V-4G5. philippe.pibarot@med.ulaval.ca or medjgd@hermes.ulaval.ca
PM:19237674Circulation1(38) (see Figure 1.2). The discriminatory ability of the projected EOA has been challenged in previous studies on the impact of PPM on mortality not relying on projected EOA but on values of EOA measured echocardiographically in vivo. Florath et al.  ADDIN REFMGR.CITE Florath200824Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacementJournal24Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacementFlorath,I.Albert,A.Rosendahl,U.Ennker,I.C.Ennker,J.2008adverse effectsAgedAortic ValveEchocardiographyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsProsthesis FailureProsthesis FittingsurgeryTime FactorsTreatment OutcomeultrasonographyNot in File11351142Am.Heart J155
Heart Institute Lahr/Baden, Lahr, Germany. ines.florath@heart-lahr.com
PM:18513530Am.Heart J1(55) demonstrated that the projected EOA determined at surgery does not sufficiently predict mismatch. Instead, the indexed EOA was obtained by echocardiography 10 days postoperatively and severe PPM was found to be an independent predictor of midterm survival. The main decrease in survival rate started 5 years after AVR. Similarly, Mohty-Echahidi et al.  ADDIN REFMGR.CITE Mohty-Echahidi2006334Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic positionJournal334Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic positionMohty-Echahidi,D.Malouf,J.F.Girard,S.E.Schaff,H.V.Grill,D.E.Enriquez-Sarano,M.E.Miller,F.A.,Jr.2006AgedAortic ValveAortic Valve InsufficiencyAortic valve replacementBody Surface AreaEchocardiographyFemaleHeart Failure,CongestiveHeart Valve ProsthesisHumansIncidenceMalemethodsMiddle AgedmortalityMultivariate AnalysisPostoperative ComplicationsPredictive Value of TestsProportional Hazards ModelsRisk Factorsstatistics & numerical dataStroke VolumesurgerySurvival RateultrasonographyNot in File420426Circulation113
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
PM:16415379Circulation1(56) identified severe PPM, measured by echocardiography within 1 year of AVR, as an independent predictor of higher late mortality in patients with 19- or 21-mm St Jude Medical prostheses. In contrast, Flameng et al.  ADDIN REFMGR.CITE Flameng2006339Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valveJournal339Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valveFlameng,W.Meuris,B.Herijgers,P.Herregods,M.C.2006adverse effectsAgedAged,80 and overAortic ValveAortic valve replacementBioprosthesisEchocardiographyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansHypertrophyHypertrophy,Left VentricularIncidenceMalemethodsMiddle AgedmortalityMultivariate AnalysisProsthesis FittingsurgerytherapyNot in File530536Ann Thorac Surg82
Department of Cardiac Surgery, University Clinic Gasthuisberg, Leuven, Belgium. willem.flameng@med.kuleuven.be
PM:16863756file://H:\Dokument\Publications on PPM\Flameng-Annals 2006.pdfThe Annals of Thoracic SurgeryAnn Thorac Surg1(57) studied a population of patients undergoing AVR using only the CE Perimount valve. The in vivo EOA was measured in a subgroup of patients and extrapolation to the entire study population was performed. Severe PPM was rarely seen when this valve was used, and moderate PPM was found to have no clinical relevance for early or late mortality or morbidity in terms of hospital readmission for cardiac reasons. Furthermore, LVH diminished in patients with moderate PPM to the same extent as in patients without PPM.  SHAPE \* MERGEFORMAT  Figure 1.2 View of a bioprosthesis and a bileaflet mechanical valve with the leaflets in the fully open position. The area shaded in pink is the effective orifice area. Reproduced from Pibarot and Dumesnil  ADDIN REFMGR.CITE Pibarot200613Prosthesis-patient mismatch: definition, clinical impact, and preventionJournal13Prosthesis-patient mismatch: definition, clinical impact, and preventionPibarot,P.Dumesnil,J.G.2006Aortic ValveBlood Loss,SurgicalBody SizeetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansmortalityPostoperative ComplicationsProsthesis DesignProsthesis FittingResearch Support,Non-U.S.Gov'tRisk FactorssurgeryTreatment OutcomeVentricular Dysfunction,LeftNot in File10221029Heart92
Research Group in Valvular Heart Disease, Laval Hospital Research Centre/Quebec Heart Institute, Laval University, Sainte-Foy, Quebec, Canada. philippe.pibarot@med.ulaval.ca
PM:16251232Heart1(10). The variation in the method of defining PPM, either through in vitro or in vivo measurements of EOA, makes it difficult to interpret the results of different studies. This inconsistency has probably contributed considerably to the controversy surrounding the topic. To add to the complexity of interpreting the clinical relevance of PPM some authors have attempted to characterize mismatch by using the internal geometric orifice area  ADDIN REFMGR.CITE Blackstone200376Prosthesis size and long-term survival after aortic valve replacementJournal76Prosthesis size and long-term survival after aortic valve replacementBlackstone,E.H.Cosgrove,D.M.Jamieson,W.R.Birkmeyer,N.J.Lemmer,J.H.,Jr.Miller,D.C.Butchart,E.G.Rizzoli,G.Yacoub,M.Chai,A.2003AgedAlgorithmsAortic ValveBioprosthesisBody Surface AreaFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityProsthesis Designstatistics & numerical datasurgerySurvival RateTime FactorsNot in File783796J.Thorac.Cardiovasc.Surg.126
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA. blackse@ccf.org
PM:14502155J.Thorac.Cardiovasc.Surg.1Medalion2000310Aortic valve replacement: is valve size important?Journal310Aortic valve replacement: is valve size important?Medalion,B.Blackstone,E.H.Lytle,B.W.White,J.Arnold,J.H.Cosgrove,D.M.2000AdolescentAdultAgedAortic ValveAortic Valve StenosisBiocompatible MaterialsBioprosthesisComparative StudyepidemiologyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedmortalityProsthesis DesignReproducibility of ResultsRetrospective StudiesRisk FactorsstandardssurgerySurvival RatetransplantationTransplantation,HomologousTreatment OutcomeNot in File963974J.Thorac.Cardiovasc.Surg.119
Department of Thoracic and Cardiovascular Surgery and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
PM:10788817J.Thorac.Cardiovasc.Surg.1(43;58). The GOA is a static manufacturing specification based on the in vitro measurement of the diameter of the prosthesis. Unfortunately, the criteria used for its measurement differ from one type of prosthesis to another. The internal GOA overestimates the EOA to a much larger extent in the case of a bioprosthesis than in that of a mechanical prosthesis  ADDIN REFMGR.CITE Tasca200622Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic StenosisJournal22Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic StenosisTasca,GiordanoMhagna,ZenPerotti,SilvanoCenturini,Pietro BerraSabatini,TonyAmaducci,AndreaBrunelli,FedericoCirillo,MarcoTomba,Margherita DallaQuiani,EugenioTroise,GiovanniPibarot,Philippe2006Aortic ValvemethodsmortalityMultivariate AnalysisRisk FactorsNot in File570576Circulation113http://circ.ahajournals.org/cgi/content/abstract/113/4/570Circulation1Muneretto200425The concept of patient-prosthesis mismatchJournal25The concept of patient-prosthesis mismatchMuneretto,C.Bisleri,G.Negri,A.Manfredi,J.2004Aortic ValveBioprosthesisBody Surface AreaHeart Valve ProsthesisHumanspathologyProsthesis DesignProsthesis FailuresurgeryNot in FileS59S62J Heart Valve Dis.13 Suppl 1
Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy. munerett@master.cci.unibs.it
PM:15225005J Heart Valve Dis.1(59;60). Florath et al.  ADDIN REFMGR.CITE Florath200824Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacementJournal24Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacementFlorath,I.Albert,A.Rosendahl,U.Ennker,I.C.Ennker,J.2008adverse effectsAgedAortic ValveEchocardiographyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsProsthesis FailureProsthesis FittingsurgeryTime FactorsTreatment OutcomeultrasonographyNot in File11351142Am.Heart J155
Heart Institute Lahr/Baden, Lahr, Germany. ines.florath@heart-lahr.com
PM:18513530Am.Heart J1(55) have also demonstrated that the internal GOA had less discriminative power than the projected indexed EOA for the prediction of postoperative outcome following AVR (see Figure 1.3).  Figure 1.3 Definition of effective orifice area (EOA), and the geometric orifice area (GOA) with: A) rigid sharp-edged aortic stenosis; B) funnel-shaped aortic stenosis. The angle  represents the valvular aperture. Reproduced from Garcia et al  ADDIN REFMGR.CITE <Refman><Cite><Author>Garcia</Author><Year>2006</Year><RecNum>357</RecNum><IDText>What do you mean by aortic valve area: geometric orifice area, effective orifice area, or gorlin area?Journal357What do you mean by aortic valve area: geometric orifice area, effective orifice area, or gorlin area?Garcia,D.Kadem,L.2006Aortic stenosisAortic ValveAortic Valve StenosisBlood Flow VelocityEchocardiographyEchocardiography,DopplerHeart CatheterizationHumanspathologyphysiopathologyPulsatile FlowradiographySeverity of Illness IndexStroke VolumeVentricular Function,LeftVentricular PressureNot in File601608J.Heart Valve Dis.15
Laboratory of Biomedical Engineering, Institut de Recherches Cliniques de Montreal, Montreal, QC, Canada. Damien.Garcia@ircm.qc.ca
PM:17044363J.Heart Valve Dis.1(61). 1.5.5 Severe prosthesis-patient mismatch Studies of native aortic valves show that aortic stenosis becomes associated with higher mortality and morbidity rates when EOAi falls to less than 0.6 cm2/m2  ADDIN REFMGR.CITE Pellikka199045The natural history of adults with asymptomatic, hemodynamically significant aortic stenosisJournal45The natural history of adults with asymptomatic, hemodynamically significant aortic stenosisPellikka,P.A.Nishimura,R.A.Bailey,K.R.Tajik,A.J.1990AdultAgedAged,80 and overAortaAortic ValveAortic Valve StenosisBlood Flow VelocityDeath,SuddendiagnosisEchocardiographyEchocardiography,DopplerElectrocardiography,AmbulatoryetiologyFemaleFollow-Up StudiesHeart CatheterizationHemodynamicsHumansMaleMiddle AgedmortalityphysiologyphysiopathologyReoperationStroke VolumeSurvival RateSyncopetherapyNot in File10121017J Am.Coll.Cardiol.15
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
PM:2312954J Am.Coll.Cardiol.1Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(62;63). This association might, if applied to prostheses, explain the lack of a clear effect of PPM on clinical outcome. Indeed, several studies have been able to independently show that severe PPM, but not moderate PPM, was an independent risk factor for early  ADDIN REFMGR.CITE Yap200726Prosthesis-patient mismatch is associated with higher operative mortality following aortic valve replacementJournal26Prosthesis-patient mismatch is associated with higher operative mortality following aortic valve replacementYap,C.H.Mohajeri,M.Yii,M.2007adverse effectsAge FactorsAgedAged,80 and overAnalysis of VarianceAortic ValveAortic Valve InsufficiencyAortic Valve StenosisAustraliabloodBody SizeCreatinineepidemiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHospital MortalityHumansLength of StayMalemethodsMiddle AgedmortalityPatient ReadmissionProspective StudiesProsthesis DesignProsthesis FailurePulmonary Wedge PressureSeverity of Illness IndexsurgeryTreatment OutcomeNot in File260264Heart Lung Circ.16
Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia. Cheng-Hon.YAP@svhm.org.au
PM:17442619Heart Lung Circ.1(52) and late survival  ADDIN REFMGR.CITE Mohty-Echahidi2006334Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic positionJournal334Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic positionMohty-Echahidi,D.Malouf,J.F.Girard,S.E.Schaff,H.V.Grill,D.E.Enriquez-Sarano,M.E.Miller,F.A.,Jr.2006AgedAortic ValveAortic Valve InsufficiencyAortic valve replacementBody Surface AreaEchocardiographyFemaleHeart Failure,CongestiveHeart Valve ProsthesisHumansIncidenceMalemethodsMiddle AgedmortalityMultivariate AnalysisPostoperative ComplicationsPredictive Value of TestsProportional Hazards ModelsRisk Factorsstatistics & numerical dataStroke VolumesurgerySurvival RateultrasonographyNot in File420426Circulation113
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
PM:16415379Circulation1Florath200824Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacementJournal24Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacementFlorath,I.Albert,A.Rosendahl,U.Ennker,I.C.Ennker,J.2008adverse effectsAgedAortic ValveEchocardiographyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsProsthesis FailureProsthesis FittingsurgeryTime FactorsTreatment OutcomeultrasonographyNot in File11351142Am.Heart J155
Heart Institute Lahr/Baden, Lahr, Germany. ines.florath@heart-lahr.com
PM:18513530Am.Heart J1Mohty20092Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionJournal2Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionMohty,DaniaDumesnil,Jean G.Echahidi,NajmeddineMathieu,PatrickDagenais,FrantoisVoisine,PierrePibarot,Philippe2009aortic valveheart valve prostheseshemodynamicsmortalityNot in File3947Journal of the American College of Cardiology530735-1097doi: DOI: 10.1016/j.jacc.2008.09.022http://www.sciencedirect.com/science/article/B6T18-4V8B39S-9/2/f7a66045e843a4c5dccfd4d747db2040Journal of the American College of Cardiology1(49;55;56). However, conflicting results have also been demonstrated concerning the clinical relevance of severe PPM. Walther et al.  ADDIN REFMGR.CITE Walther2006333Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacementJournal333Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacementWalther,ThomasRastan,ArdawanFalk,VolkmarLehmann,SvenGarbade,JensFunkat,Anne K.Mohr,Friedrich W.Gummert,Jan F.2006Aortic ValveAortic valve replacementBody Surface AreamethodsmortalityRegression AnalysisRisk FactorssurgerySurvival AnalysisNot in File1519European Journal of Cardio-Thoracic Surgery30http://ejcts.ctsnetjournals.org/cgi/content/abstract/30/1/15European Journal of Cardio-Thoracic Surgery1(64) evaluated a relatively large but heterogeneous study population and were able to show that moderate mismatch was a predictor of impaired long-term survival after AVR. Surprisingly, the authors found that patients with severe mismatch demonstrated slightly better survival than patients with moderate PPM. According to a study by Howell et al.  ADDIN REFMGR.CITE Howell2006329Patient-prosthesis mismatch does not affect survival following aortic valve replacementJournal329Patient-prosthesis mismatch does not affect survival following aortic valve replacementHowell,N.J.Keogh,B.E.Barnet,V.Bonser,R.S.Graham,T.R.Rooney,S.J.Wilson,I.C.Pagano,D.2006Adultadverse effectsAgedAged,80 and overAortic ValveAortic valve replacementBody Surface AreaEpidemiologic MethodsFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalitypathologyProsthesis DesignProsthesis FittingsurgeryTreatment OutcomeNot in File1014Eur.J Cardiothorac.Surg30
Department of Cardiothoracic Surgery, University Hospital NHS Foundation Trust, Birmingham, UK
PM:16723251Eur.J Cardiothorac.Surg1(65), severe PPM occurred in 4-10% of patients undergoing AVR using both the EOAi and GOAi. The presence of severe PPM, however, did not translate into increased in-hospital mortality, or decreased survival after discharge from hospital. 1.5.6 Homogeneity and propensity scoring Some authors have attempted to evaluate the impact of PPM in a strictly defined group of patients or a homogeneous study population. Mascherbauer et al.  ADDIN REFMGR.CITE Mascherbauer200827Moderate patient-prosthesis mismatch after valve replacement for severe aortic stenosis has no impact on short-term and long-term mortalityJournal27Moderate patient-prosthesis mismatch after valve replacement for severe aortic stenosis has no impact on short-term and long-term mortalityMascherbauer,J.Rosenhek,R.Fuchs,C.Pernicka,E.Klaar,U.Scholten,C.Heger,M.Wollenek,G.Maurer,G.Baumgartner,H.2008Aortic ValveFemalemortalityMultivariate AnalysisPrognosisNot in File16391645Heart94http://heart.bmj.com/cgi/content/abstract/94/12/1639Heart1(66) evaluated the impact of moderate PPM on survival after AVR in patients referred for surgery for isolated severe aortic stenosis. No major impact on perioperative and long-term survival after AVR could be demonstrated. As previously demonstrated  ADDIN REFMGR.CITE Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1(9) patients with PPM were significantly older, more hypertensive and symptomatic, had a higher incidence of coronary artery disease and triple vessel disease, and a higher EuroSCORE. In contrast, Tasca et al.  ADDIN REFMGR.CITE Tasca200622Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic StenosisJournal22Impact of Prosthesis-Patient Mismatch on Cardiac Events and Midterm Mortality After Aortic Valve Replacement in Patients With Pure Aortic StenosisTasca,GiordanoMhagna,ZenPerotti,SilvanoCenturini,Pietro BerraSabatini,TonyAmaducci,AndreaBrunelli,FedericoCirillo,MarcoTomba,Margherita DallaQuiani,EugenioTroise,GiovanniPibarot,Philippe2006Aortic ValvemethodsmortalityMultivariate AnalysisRisk FactorsNot in File570576Circulation113http://circ.ahajournals.org/cgi/content/abstract/113/4/570Circulation1(59) analyzed patients with isolated aortic valve stenosis, and reported higher midterm mortality and more cardiac events for patients with PPM defined as EOAid"0.8 cm2/m2. Although homogeneity may be required for a valid assessment of PPM, such a study may be limited as it cannot be excluded that PPM could be a clinically important phenomenon in patients with coronary artery disease, diseases of the ascending aorta, or in cases where the etiology of the valve disease is something other than stenosis. For instance, patients undergoing concomitant coronary artery by-pass grafting (CABG) are exposed to limited oxygen delivery to the LV myocardium, due to both prolonged global ischemia and residual coronary ischemia after revascularization  ADDIN REFMGR.CITE Venugopal2009112Conditioning the heart during surgeryJournal112Conditioning the heart during surgeryVenugopal,VinodLudman,AndrewYellon,Derek M.Hausenloy,Derek J.2009CardioplegiaCardioprotectionHeartIntermittent cross-clamp fibrillationIschaemic postconditioningIschaemic preconditioningPharmacological preconditioningRemote ischaemic preconditioningsurgeryNot in File977987European Journal of Cardio-Thoracic Surgery351010-7940doi: DOI: 10.1016/j.ejcts.2009.02.014http://www.sciencedirect.com/science/article/B6T35-4VXCG15-3/2/cfdac00a06e5a02a92187c773fce6e76European Journal of Cardio-Thoracic Surgery1(67). Therefore, hypothetically a mismatch in the supply and demand for energy could occur in patients with PPM due to the higher LV work load. This would in theory translate into a higher rate of cardiac complications and perhaps mortality. Limiting the study population to exclusively surgery for aortic stenosis may therefore not reveal the true clinical impact of PPM. Baseline differences in patient characteristics, as well as confounders that are not adjusted for, could explain conflicting findings in previous publications. A randomized controlled trial could eliminate the effect of several confounding variables and allow analysis with a real control group. This solution is hardly feasible due ethical reasons. Therefore, a propensity score analysis may be performed to balance the baseline covariates between the groups being compared. Urso et al.  ADDIN REFMGR.CITE Urso200929Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survivalJournal29Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survivalUrso,S.Sadaba,R.Vives,M.Trujillo,J.Beltrame,S.Soriano,B.Piqueras,L.miz-Echevarria,G.2009AgedAortic ValveBioprosthesisBody Surface AreaFemalemethodsmortalitysurgerySurvival AnalysisNot in File248255J Heart Valve Dis.18
Department of Cardiac Surgery, Clinica Capio, Albacete, Spain. stefano_urso@inwind.it
PM:19557978J Heart Valve Dis.1(68) evaluated elderly patients (age>75 years) undergoing AVR using a propensity score and multivariate logistic regression analysis, and reported that long-term survival was not significantly impaired in patients with moderate PPM despite an incidence of more than 40%. In a study by Kohsaka et al.  ADDIN REFMGR.CITE Kohsaka200823Prosthesis-patient mismatch affects long-term survival after mechanical valve replacementJournal23Prosthesis-patient mismatch affects long-term survival after mechanical valve replacementKohsaka,S.Mohan,S.Virani,S.Lee,V.V.Contreras,A.Reul,G.J.Coulter,S.A.2008Adultadverse effectsAgedanatomy & histologyAortic ValveAortic Valve StenosisBody SizeBody Surface AreaFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalitysurgerySurvival AnalysisNot in File10761080J Thorac Cardiovasc Surg135
Division of Cardiology, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex, USA. sk2798@columbia.edu
PM:18455587J Thorac Cardiovasc Surg1(69), propensity score adjustment was used to reduce baseline differences in patient characteristics in order to avoid treatment selection bias. The study population was homogeneous in that only mechanical AVR was evaluated. The authors reported a significant association between moderate and severe PPM and long-term survival following multivariate adjustment and modeling with propensity scoring. The authors acknowledged the limitation that most of the reference EOA values for the aortic valve prostheses were derived from the results of a single study. 1.5.7 Prosthesis-patient mismatch and left ventricular mass regression Patients with aortic valve stenosis and/or aortic regurgitation are subjected to increased pressure and/or volume load of the left ventricle, leading to either concentric or eccentric LVH  ADDIN REFMGR.CITE Lamb20021Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitationJournal1Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitationLamb,H.J.Beyerbacht,H.P.de,Roos A.van der,Laarse A.Vliegen,H.W.Leujes,F.Bax,J.J.van der Wall,E.E.2002AdultAgedAortic ValveAortic Valve InsufficiencyAortic valve replacementAortic Valve StenosisBlood Flow VelocityComparative StudydiagnosisDiastoleFemaleHeart Valve ProsthesisHumansHypertrophyLeft ventricular massLeft ventricular mass indexMagnetic Resonance ImagingMaleMiddle AgedObserver VariationphysiologyphysiopathologysurgeryVentricular Function,LeftVentricular RemodelingNot in File21822188J Am Coll Cardiol40
Department of Radiology, Leiden University Medical Center, The Netherlands. H.J.Lamb@lumc.nl
PM:12505232Journal of the American College of CardiologyJ Am Coll Cardiol1(70). LVH is an independent risk factor for cardiovascular events and mortality and it has been shown that the long term survival after AVR is directly related to the extent of LVH regression  ADDIN REFMGR.CITE Levy199038Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart StudyJournal38Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart StudyLevy,D.Garrison,R.J.Savage,D.D.Kannel,W.B.Castelli,W.P.1990adverse effectsbloodBlood PressureCardiomegalyDiabetes ComplicationsdiagnosisEchocardiographyFemaleFollow-Up StudiesHumansLipidsMaleMiddle AgedmortalityMultivariate AnalysisPrognosisRisk FactorsSmokingNot in File15611566N Engl J Med322
Framingham Heart Study, Mass. 01701
PM:2139921The New England Journal of MedicineN Engl J Med1(27). It has been suggested that PPM could jeopardize the regression of LVH. Fuster et al.  ADDIN REFMGR.CITE Garcia Fuster2007352Prosthesis patient mismatch with latest generation supra-annular prostheses. The beginning of the end?Journal352Prosthesis patient mismatch with latest generation supra-annular prostheses. The beginning of the end?Garcia Fuster,RafaelEstevez,VanesaRodriguez,IgnacioCanovas,SergioGil,OscarHornero,FernandoMartinez-Leon,Juan2007mortalityNot in File462469Interact CardioVasc Thorac Surg6http://icvts.ctsnetjournals.org/cgi/content/abstract/6/4/462Interactive CardioVascular and Thoracic SurgeryInteract CardioVasc Thorac Surg1(71) reported that PPM was not an independent predictor of mortality by itself, but a promoter of the left ventricular mass index (LVMI). Patients with PPM and high preoperative LVMI demonstrated impaired survival and a lower LVMR rate than patients without PPM and LVH. Once again, conflicting data suggest the contrary. Bov and colleagues  ADDIN REFMGR.CITE Bove2006356Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcomeJournal356Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcomeBove,ThierryVan Belleghem,YvesFrancois,KatrienCaes,FrankVan Overbeke,HansVan Nooten,Guido2006Aortic ValveAortic valve replacementBioprosthesisLeft ventricular mass regressionmortalityStentless prosthesisNot in File706713European Journal of Cardio-Thoracic Surgery30http://www.sciencedirect.com/science/article/B6T35-4KTVP15-2/2/09c9b102ce9d4aa01b63f5d142005735European Journal of Cardio-Thoracic Surgery1(72) evaluated survival and hemodynamic outcome following AVR with stentless or stented bioprostheses. They demonstrated that the preexistence of advanced LVH and systemic arterial hypertension are the major obstacles for LVMR despite otherwise successful AVR. 1.5.8 Prosthesis-patient mismatch quality of life Koch and co-workers  ADDIN REFMGR.CITE Koch2005313Impact of prosthesis-patient size on functional recovery after aortic valve replacementJournal313Impact of prosthesis-patient size on functional recovery after aortic valve replacementKoch,C.G.Khandwala,F.Estafanous,F.G.Loop,F.D.Blackstone,E.H.2005Adultadverse effectsAnimalsAortic ValveAortic Valve InsufficiencyBody SizeBody Surface AreaData CollectionFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansLogistic ModelsMalemethodsMiddle AgedmortalityProsthesis DesignQuality of LifeRisk FactorsstandardssurgeryTreatment OutcomeNot in File32213229Circulation111
Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. kochc@ccf.org
PM:15956129Circulation1(73) have previously published a study on the relationship between prosthetic valve size (GOA) and the Duke Activity Status Index following AVR. Analyzing data from 1014 patients, the authors reported an overall improvement of functional quality of life (QoL) for all patients undergoing AVR. GOAi did not influence functional recovery after AVR, even for thresholds that would be considered as severe mismatch for patient size. These findings are in agreement with those reported by Vicchio and colleagues  ADDIN REFMGR.CITE Vicchio2009356Prosthesis-patient mismatch does not affect survival and quality of life in the elderly having bileaflet prostheses implantJournal356Prosthesis-patient mismatch does not affect survival and quality of life in the elderly having bileaflet prostheses implantVicchio,M.De,Feo M.Cotrufo,M.2009Quality of LifeNot in File787788J Thorac Cardiovasc Surg138PM:19698882J Thorac Cardiovasc Surg1(74), using in vivo EOA and small bileaflet prostheses, showing that QoL improved equally well regardless of PPM in a population of septuagenarians. In contrast, Ennker et al.  ADDIN REFMGR.CITE Ennker20057Stentless bioprostheses in small aortic roots: impact of patient-prosthesis mismatch on survival and quality of lifeJournal7Stentless bioprostheses in small aortic roots: impact of patient-prosthesis mismatch on survival and quality of lifeEnnker,J.Rosendahl,U.Albert,A.Dumlu,E.Ennker,I.C.Florath,I.2005Activities of Daily LivingAgedAortic ValveAortic valve replacementAtrial FibrillationBioprosthesiscomplicationsDiabetes ComplicationsFatigueFemaleFollow-Up StudiesHeartHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansHypertrophyLogistic ModelsMalemethodsmortalityPain MeasurementProportional Hazards ModelsProsthesis DesignProsthesis FittingpsychologyQuality of LifeRegression AnalysisRisk FactorsSex FactorsSleepSocial IsolationsurgeryTimeNot in File523530J Heart Valve Dis.14
Herzzentrum Lahr/Baden, Hohbergweg 2, Lahr, Germany. juergen.ennker@heart-lahr.com
PM:16116880J Heart Valve Dis.1(75) identified PPM (EOAi 0.75Kunadian2007103Meta-Analysis of Valve Hemodynamics and Left Ventricular Mass Regression for Stentless Versus Stented Aortic ValvesJournal103Meta-Analysis of Valve Hemodynamics and Left Ventricular Mass Regression for Stentless Versus Stented Aortic ValvesKunadian,B.Vijayalakshmi,K.Thornley,A.R.de Belder,M.A.Hunter,S.Kendall,S.Graham,R.Stewart,M.Thambyrajah,J.Dunning,J.2007Aortic ValveHemodynamicsmethodsNot in File7378Ann Thorac Surg8400034975The Annals of Thoracic SurgeryAnn Thorac Surg1(76). In a recent study by Urso et al.  ADDIN REFMGR.CITE Urso200929Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survivalJournal29Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survivalUrso,S.Sadaba,R.Vives,M.Trujillo,J.Beltrame,S.Soriano,B.Piqueras,L.miz-Echevarria,G.2009AgedAortic ValveBioprosthesisBody Surface AreaFemalemethodsmortalitysurgerySurvival AnalysisNot in File248255J Heart Valve Dis.18
Department of Cardiac Surgery, Clinica Capio, Albacete, Spain. stefano_urso@inwind.it
PM:19557978J Heart Valve Dis.1(68) PPM was found to be associated with a lower physical component score of the SF-12 quality of life test. However, the authors pointed out that the multifactorial nature of quality of life does not permit the conclusion that this association depends exclusively on PPM. 1.5.9 Prosthesis-patient mismatch and aortic valve insufficiency The different etiologies of aortic valve disease leading to AVR may be unaccounted-for confounding variables when evaluating the impact of PPM after AVR. Aortic valve insufficiency (AVI) has several different etiologies and effects on the left ventricle, compared to the stenotic valve. It may therefore be hypothesized that the incidence of PPM, the extent of postoperative remodeling and the clinical effect of PPM differ between patients with AVI and AS. In a recent study, Price et al.  ADDIN REFMGR.CITE Price200987Prosthesis-patient mismatch is less frequent and more clinically indolent in patients operated for aortic insufficiencyJournal87Prosthesis-patient mismatch is less frequent and more clinically indolent in patients operated for aortic insufficiencyPrice,JoelLapierre,HarryRessler,LadislausLam,BuuMesana,Thierry G.Ruel,Marc2009Aortic ValveHeartHeart FailureIncidencemethodsOdds RatioVentricular FunctionVentricular RemodelingNot in File639645The Journal of Thoracic and Cardiovascular Surgery13800225223The Journal of Thoracic and Cardiovascular Surgery1(77) reported that PPM was encountered less frequently in patients with AVI and is more clinically indolent. The authors concluded that special technical maneuvers to facilitate the implantation of a valve with larger EOAi may increase perioperative morbidity and mortality and therefore do not seem justified in patients with AI on the basis of improving long-term survival or freedom from symtoms of congestive heart failure and death 1.6 Postoperative heart failure As early as in 1967, Kirklin noted that early death after cardiac surgery was often related to cardiac output  ADDIN REFMGR.CITE Kirklin196758Low cardiac output after open intracardiac operationsJournal58Low cardiac output after open intracardiac operationsKirklin,J.W.Rastelli,G.C.1967Blood Gas AnalysisCardiac OutputHeart Septal DefectsHeart Valve ProsthesisHumansPostoperative Complicationsprevention & controlShock,SurgicalsurgeryTetralogy of FallotNot in File117122Prog.Cardiovasc Dis.10PM:4862746Prog.Cardiovasc Dis.1(78). Improvements in surgical techniques, prosthetic design, and myocardial protection as well as earlier patient referral have led to a decrease in operative risks associated with AVR during recent decades  ADDIN REFMGR.CITE Lung2007108Valvular Heart Disease in the Community: A European ExperienceJournal108Valvular Heart Disease in the Community: A European ExperienceLung,BernardBaron,GabrielTornos,PilarGohlke-Barwolf,ChristaButchart,Eric G.Vahanian,Alec2007analysisAortic stenosissurgeryVentricular functionNot in File609661Current Problems in Cardiology32http://www.sciencedirect.com/science/article/B75B7-4R15XF4-6/2/3f7c38fe8596664588271ff93160475eCurrent Problems in Cardiology1(79). However, although the majority of patients considered for AVR have normal LV systolic function  ADDIN REFMGR.CITE Stout2007139Indications for Aortic Valve Replacement in Aortic StenosisJournal139Indications for Aortic Valve Replacement in Aortic StenosisStout,Karen K.Otto,Catherine M.2007Aortic stenosisAortic ValvediagnosismethodstherapyNot in File1425J Intensive Care Med22http://jic.sagepub.com/cgi/content/abstract/22/1/14Journal of Intensive Care MedicineJ Intensive Care Med1(80), myocardial performance may deteriorate while awaiting surgery due to the progress of AS or increasing aortic regurgitation with subsequent LVH and dilatation. Also, asymptomatic patients may remain undetected for many years, and often present late in the natural history of the disease due to the development of symptoms secondary to ventricular, rather than valvular, disease  ADDIN REFMGR.CITE Ding200956Predictors of survival after aortic valve replacement in patients with low-flow and high-gradient aortic stenosisJournal56Predictors of survival after aortic valve replacement in patients with low-flow and high-gradient aortic stenosisDing,Wen HongLam,Yat YinDuncan,AlisonLi,WeiLim,EricKaya,Mehmet G.Chung,RobinPepper,John R.Henein,Michael Y.2009AgedAortic ValveCreatininemethodsmortalityMultivariate AnalysissurgeryNot in Filehfp096Eur J Heart Failhttp://eurjhf.oxfordjournals.org/cgi/content/abstract/hfp096v1European Journal of Heart FailureEur J Heart Fail1(81). Furthermore, preoperative echocardiographic assessment may be influenced by physiological and investigator-dependent variations and may not always reflect the myocardial status adequately at the time of surgery. LV function may also deteriorate intraoperatively secondary to poor myocardial protection or technical problems leading to prolonged aortic cross-clamp and cardiopulmonary bypass (CPB) times. The preoperative deterioration in LV diastolic and systolic function have important implications for morbidity and mortality before and after AVR  ADDIN REFMGR.CITE Villari199251Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic and diastolic functionJournal51Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic and diastolic functionVillari,B.Hess,O.M.Kaufmann,P.Krogmann,O.N.Grimm,J.Krayenbuehl,H.P.1992AdolescentAdultAgedAnalysis of VarianceAortic ValveAortic Valve InsufficiencyAortic Valve StenosisChi-Square DistributionDiastoleFemaleHumansLeast-Squares AnalysisLinear ModelsMaleMiddle AgedMotion Pictures as TopicphysiopathologyradiographySystoleVentricular Function,LeftNot in File927934Am.J Cardiol.69
Department of Internal Medicine, Cardiology, University Hospital, Zurich, Switzerland
PM:1550023Am.J Cardiol.1Kumpuris198250Importance of preoperative hypertrophy, wall stress and end-systolic dimension as echocardiographic predictors of normalization of left ventricular dilatation after valve replacement in chronic aortic insufficiencyJournal50Importance of preoperative hypertrophy, wall stress and end-systolic dimension as echocardiographic predictors of normalization of left ventricular dilatation after valve replacement in chronic aortic insufficiencyKumpuris,A.G.Quinones,M.A.Waggoner,A.D.Kanon,D.J.Nelson,J.G.Miller,R.R.1982AdolescentAdultAgedAortic ValveAortic Valve InsufficiencyCardiac VolumeCardiomegalyChronic DiseasediagnosisEchocardiographyFemaleHeart Valve ProsthesisHeart VentriclesHumansMaleMiddle AgedphysiopathologyPreoperative CareStress,MechanicalsurgerySystoleNot in File10911100Am.J Cardiol.49PM:6461239Am.J Cardiol.1Lund199756Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanismsJournal56Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanismsLund,O.Flo,C.Jensen,F.T.Emmertsen,K.Nielsen,T.T.Rasmussen,B.S.Hansen,O.K.Pilegaard,H.K.Kristensen,L.H.1997AdultAgedAged,80 and overAortic ValveAortic valve replacementAortic Valve StenosisFemaleHeart Valve Prosthesis ImplantationHumansLogistic ModelsMaleMiddle AgedModels,CardiovascularModels,StatisticalmortalityphysiopathologyPrognosisProspective StudiesRisk FactorssurgerySurvival AnalysisVentricular Function,LeftNot in File19771987Eur Heart J18
Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark
PM:9447328European Heart JournalEur Heart J1Villari199552Normalization of diastolic dysfunction in aortic stenosis late after valve replacementJournal52Normalization of diastolic dysfunction in aortic stenosis late after valve replacementVillari,B.Vassalli,G.Monrad,E.S.Chiariello,M.Turina,M.Hess,O.M.1995AdultAortic ValveAortic Valve StenosisFollow-Up StudiesHeart VentriclesHemodynamicsHumansmethodsMiddle AgedpathologyphysiopathologysurgeryVentricular Function,LeftNot in File23532358Circulation91
Department of Internal Medicine, University Hospital, Zurich, Switzerland
PM:7729021Circulation1Faggiano199453Left Ventricular Remodeling and Function in Adult Aortic StenosisJournal53Left Ventricular Remodeling and Function in Adult Aortic StenosisFaggiano,PompilioRusconi,CesareGhizzoni,GiuseppeSabatini,Tony1994AdultVentricular RemodelingNot in File10331038Angiology45http://ang.sagepub.com/cgi/content/abstract/45/12/1033Angiology1Bech-Hanssen199954Gender differences in patients with severe aortic stenosis: impact on preoperative left ventricular geometry and function, as well as early postoperative morbidity and mortalityJournal54Gender differences in patients with severe aortic stenosis: impact on preoperative left ventricular geometry and function, as well as early postoperative morbidity and mortalityBech-Hanssen,O.Wallentin,I.Houltz,E.Beckman,Suurkula M.Larsson,S.Caidahl,K.1999Aortic ValveAortic Valve StenosisBlood Flow VelocityBody Surface AreaCoronary Care UnitsEchocardiography,Doppler,ColorFemaleFollow-Up StudiesHeart Valve Prosthesis ImplantationHeart VentriclesHospital MortalityHumansIncidenceMalemethodsMiddle AgedMorbiditymortalityMyocardial ContractionObserver VariationphysiologyphysiopathologyPostoperative ComplicationsProspective StudiesSeverity of Illness IndexSex Characteristicsstatistics & numerical dataStroke VolumesurgerySurvival RateTreatment OutcomeultrasonographyVentricular Function,LeftNot in File2430Eur J Cardiothorac.Surg15
Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden. odd.bech-hanssen@sahlgrenska.se
PM:10077369Eur J Cardiothorac.Surg1(82-87). The deleterious effects of LV systolic impairment in patients with severe AS have been demonstrated by several previous studies, which amongst others, have identified preoperative LV dysfunction and lack of myocardial contractile reserve as prognostic indicators of surgical outcome  ADDIN REFMGR.CITE Ding200956Predictors of survival after aortic valve replacement in patients with low-flow and high-gradient aortic stenosisJournal56Predictors of survival after aortic valve replacement in patients with low-flow and high-gradient aortic stenosisDing,Wen HongLam,Yat YinDuncan,AlisonLi,WeiLim,EricKaya,Mehmet G.Chung,RobinPepper,John R.Henein,Michael Y.2009AgedAortic ValveCreatininemethodsmortalityMultivariate AnalysissurgeryNot in Filehfp096Eur J Heart Failhttp://eurjhf.oxfordjournals.org/cgi/content/abstract/hfp096v1European Journal of Heart FailureEur J Heart Fail1Monin200342Low-Gradient Aortic Stenosis: Operative Risk Stratification and Predictors for Long-Term Outcome: A Multicenter Study Using Dobutamine Stress HemodynamicsJournal42Low-Gradient Aortic Stenosis: Operative Risk Stratification and Predictors for Long-Term Outcome: A Multicenter Study Using Dobutamine Stress HemodynamicsMonin,Jean LucQuere,Jean PaulMonchi,MehranPetit,HeleneBaleynaud,SergeChauvel,ChristophePop,CameliaOhlmann,PatrickLelguen,ClaudeDehant,PatrickTribouilloy,ChristopheGueret,Pascal2003Aortic ValveHemodynamicsmethodsmortalitysurgeryNot in File319324Circulation108http://circ.ahajournals.org/cgi/content/abstract/108/3/319Circulation1(36;81). However, studies evaluating postoperative heart failure (PHF), its causes and risk factors following AVR are scarce although this condition remains an important determinant of poor early and late outcome  ADDIN REFMGR.CITE Maganti2005126Predictors of Low Cardiac Output Syndrome After Isolated Aortic Valve SurgeryJournal126Predictors of Low Cardiac Output Syndrome After Isolated Aortic Valve SurgeryMaganti,Manjula D.Rao,VivekBorger,Michael A.Ivanov,JoanDavid,Tirone E.2005analysisAortic ValveCardiac OutputFemaleHeart FailuremethodsmortalityOdds RatioRegression AnalysissurgeryNot in FileI448Circulation112http://circ.ahajournals.org/cgi/content/abstract/112/9_suppl/I-448Circulation1Vanky2007137Long-term consequences of postoperative heart failure after surgery for aortic stenosis compared with coronary surgeryJournal137Long-term consequences of postoperative heart failure after surgery for aortic stenosis compared with coronary surgeryVanky,F.B.Hakanson,E.Svedjeholm,R.2007adverse effectsAgedAged,80 and overAortic stenosisAortic ValveAortic Valve StenosisAtrial FibrillationCoronary Artery BypassetiologyFemaleHeart FailureHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityRisk FactorsStrokesurgerySurvivalSurvival AnalysisSwedenTime FactorsNot in File20362043Ann.Thorac Surg83
Department of Cardiothoracic Surgery, University Hospital, Linkoping, Sweden
PM:17532392Ann.Thorac Surg1Vanky2006138Risk factors for postoperative heart failure in patients operated on for aortic stenosisJournal138Risk factors for postoperative heart failure in patients operated on for aortic stenosisVanky,F.B.Hakanson,E.Tamas,E.Svedjeholm,R.2006AgedanalysisAortic stenosisAortic ValveAortic Valve StenosisepidemiologyFemaleHeart FailureHumansMalemethodsmortalityMyocardial InfarctionPostoperative ComplicationsRegression AnalysisRisk FactorssurgerySwedenNot in File12971304Ann.Thorac Surg81
Department of Cardiothoracic Surgery, University Hospital, Linkoping, Sweden
PM:16564261Ann.Thorac Surg1(88-90). In general, the treatment of PHF appears uniform, regardless of the preceeding procedure and underlying cause  ADDIN REFMGR.CITE Gorman200060Circulatory management of the unstable cardiac patientJournal60Circulatory management of the unstable cardiac patientGorman,J.H.,IIIGorman,R.C.Milas,B.L.Acker,M.A.2000Assisted CirculationCardiac OutputCardiac Output,LowCardiac Surgical ProceduresExtracorporeal Membrane OxygenationHemodynamicsHumansIntraoperative ComplicationsMyocardial ContractionPostoperative ComplicationsShocksurgerytherapyNot in File316325Semin.Thorac Cardiovasc Surg12
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
PM:11154727Semin.Thorac Cardiovasc Surg1(91). Furthermore, in spite of the grave consequences of PHF there is no generally accepted definition of the condition. Most of the previously published results derive from studies on CABG patients. In 1996, Rao et al.  ADDIN REFMGR.CITE Rao199659Predictors of low cardiac output syndrome after coronary artery bypassJournal59Predictors of low cardiac output syndrome after coronary artery bypassRao,V.Ivanov,J.Weisel,R.D.Ikonomidis,J.S.Christakis,G.T.David,T.E.1996AgedbloodBlood PressureCardiac OutputCardiac Output,LowcomplicationsCoronary Artery BypassDiabetes ComplicationsetiologyFemaleHumansMaleMiddle AgedmortalityMyocardial InfarctionOdds RatiophysiopathologyPostoperative ComplicationsPrognosisProspective StudiesSex FactorssurgerySurvival RateSyndromeVentricular Dysfunction,LeftNot in File3851J Thorac Cardiovasc Surg112
Division of Cardiovascular Surgery, The Toronto Hospital, Ontario, Canada
PM:8691884J Thorac Cardiovasc Surg1(92) reported a 9% incidence of low cardiac output syndrome (LCOS) following CABG, with an operative mortality of 17% compared to 1% for those without LCOS. Efforts to prevent PHF and to tailor causal treatment following AVR require greater knowledge and insight into these issues. 1.7 Diastolic dysfunction in patients with aortic valve disease Diastolic heart failure has been demonstrated in 50% of patients in the elderly population, causing symptomatic congestive heart failure despite a normal LV ejection fraction (LVEF)  ADDIN REFMGR.CITE Paulus2007353How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of CardiologyJournal353How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of CardiologyPaulus,Walter J.Tschope,CarstenSanderson,John E.Rusconi,CesareFlachskampf,Frank A.Rademakers,Frank E.Marino,PaoloSmiseth,Otto A.De Keulenaer,GillesLeite-Moreira,Adelino F.Borbely,AttilaEdes,IstvanHandoko,Martin LouisHeymans,StephanePezzali,NataliaPieske,BurkertDickstein,KennethFraser,Alan G.Brutsaert,Dirk L.2007diagnosisEchocardiographytherapyNot in File25392550Eur Heart Jhttp://eurheartj.oxfordjournals.org/cgi/content/abstract/ehm037v1European Heart JournalEur Heart J1(93). The pathophysiological condition of heart failure in aortic stenosis derives from increased pressure load on the LV, resulting in myocardial hypertrophy and diastolic dysfunction, in addition to systolic dysfunction. Dineen and colleagues  ADDIN REFMGR.CITE Dineen1986119Aortic valve stenosis: comparison of patients with to those without chronic congestive heart failureJournal119Aortic valve stenosis: comparison of patients with to those without chronic congestive heart failureDineen,E.Brent,B.N.1986AgedAortic ValveAortic Valve StenosisBlood PressureCardiac OutputetiologyFemaleHeart Failure,CongestiveHeart VentriclesHemodynamic ProcessesHumansMaleMiddle AgedphysiopathologyPrognosisPulmonary Wedge PressureStressStroke VolumeNot in File419422Am.J.Cardiol.57PM:3946257Am.J.Cardiol.1(94) demonstrated that the LV ejection fraction was preserved in 60% of patients with aortic stenosis and diastolic heart failure (DHF). Studies on DHF after AVR and the relation between PPM and diastolic dysfunction are scarce  ADDIN REFMGR.CITE Lund199756Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanismsJournal56Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanismsLund,O.Flo,C.Jensen,F.T.Emmertsen,K.Nielsen,T.T.Rasmussen,B.S.Hansen,O.K.Pilegaard,H.K.Kristensen,L.H.1997AdultAgedAged,80 and overAortic ValveAortic valve replacementAortic Valve StenosisFemaleHeart Valve Prosthesis ImplantationHumansLogistic ModelsMaleMiddle AgedModels,CardiovascularModels,StatisticalmortalityphysiopathologyPrognosisProspective StudiesRisk FactorssurgerySurvival AnalysisVentricular Function,LeftNot in File19771987Eur Heart J18
Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark
PM:9447328European Heart JournalEur Heart J1Gjertsson2005359Preoperative moderate to severe diastolic dysfunction: A novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosisJournal359Preoperative moderate to severe diastolic dysfunction: A novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosisGjertsson,PeterCaidahl,KennethFarasati,MahmoodOden,AndersBech-Hanssen,Odd2005EchocardiographymortalityNot in File890896Journal of Thoracic and Cardiovascular Surgery129http://www.sciencedirect.com/science/article/B6WMF-4FWFR5W-1D/2/d7497c65a2a8546b247d4b05b0b341d7Journal of Thoracic and Cardiovascular Surgery1(84;95), and the effect of AVR on diastolic function in patients with aortic regurgitation has not been studied. A previous study using LV bi-plane angiography and high-fidelity pressure measurements has shown that diastolic function in patients with aortic valve stenosis deteriorates immediately after AVR. At follow-up, diastolic function is seen to improve gradually and may be completely normalized long after AVR  ADDIN REFMGR.CITE Villari199552Normalization of diastolic dysfunction in aortic stenosis late after valve replacementJournal52Normalization of diastolic dysfunction in aortic stenosis late after valve replacementVillari,B.Vassalli,G.Monrad,E.S.Chiariello,M.Turina,M.Hess,O.M.1995AdultAortic ValveAortic Valve StenosisFollow-Up StudiesHeart VentriclesHemodynamicsHumansmethodsMiddle AgedpathologyphysiopathologysurgeryVentricular Function,LeftNot in File23532358Circulation91
Department of Internal Medicine, University Hospital, Zurich, Switzerland
PM:7729021Circulation1(85). Furthermore, impaired LVMR following AVR may be detrimental inasmuch as persistent LVH is one of the known causes of diastolic heart failure  ADDIN REFMGR.CITE Fischer2003354Prevalence of left ventricular diastolic dysfunction in the community: Results from a Doppler echocardiographic-based survey of a population sampleJournal354Prevalence of left ventricular diastolic dysfunction in the community: Results from a Doppler echocardiographic-based survey of a population sampleFischer,M.Baessler,A.Hense,H.W.Hengstenberg,C.Muscholl,M.Holmer,S.Doring,A.Broeckel,U.Riegger,G.Schunkert,H.2003AgedEchocardiographyRisk FactorsNot in File320328Eur Heart J24http://eurheartj.oxfordjournals.org/cgi/content/abstract/24/4/320European Heart JournalEur Heart J1(96). Previous studies have suggested that the extent of LVMR is strongly and independently related to the presence of PPM  ADDIN REFMGR.CITE Del Rizzo19998Factors affecting left ventricular mass regression after aortic valve replacement with stentless valvesJournal8Factors affecting left ventricular mass regression after aortic valve replacement with stentless valvesDel Rizzo,D.F.Abdoh,A.Cartier,P.Doty,D.Westaby,S.1999AgedAortic ValveBioprosthesisFemaleFollow-Up StudiesHeart Valve ProsthesisHeart VentriclesHumansMalepathologyProsthesis DesignResearch Support,Non-U.S.Gov'tsurgeryTime FactorsultrasonographyNot in File114120Semin.Thorac.Cardiovasc.Surg.11
University of Manitoba, Winnipeg, Canada
PM:10660178Semin.Thorac.Cardiovasc.Surg.1Tasca2005309Impact of valve prosthesis-patient mismatch on left ventricular mass regression following aortic valve replacementJournal309Impact of valve prosthesis-patient mismatch on left ventricular mass regression following aortic valve replacementTasca,G.Brunelli,F.Cirillo,M.DallaTomba,M.Mhagna,Z.Troise,G.Quaini,E.2005adverse effectsAgedAortic ValveAortic Valve StenosisBioprosthesisEchocardiography,DoppleretiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart VentriclesHumansHypertrophy,Left VentricularMaleMultivariate AnalysisPreoperative CareProsthesis FittingsurgeryultrasonographyNot in File505510Ann.Thorac.Surg.79
Department of Cardiac Surgery, Poliambulanza Hospital, Brescia, Italy. cch-segreteria.poli@poliambulanza.it
PM:15680824Ann.Thorac.Surg.1(19;20). Others have reported that patients with PPM or small prostheses exhibited significant reductions in LV mass and, on this basis, concluded that PPM was not an important issue  ADDIN REFMGR.CITE Hanayama200214Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantJournal14Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantHanayama,N.Christakis,G.T.Mallidi,H.R.Joyner,C.D.Fremes,S.E.Morgan,C.D.Mitoff,P.R.Goldman,B.S.2002AdultAgedAnthropometryAortic ValveepidemiologyetiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedPostoperative ComplicationsPrevalenceProspective StudiesProsthesis Designstatistics & numerical datasurgerySurvival RateNot in File18221829Ann.Thorac.Surg.73
Division of Cardiovascular Surgery of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
PM:12078776file://H:\Dokument\Publications on PPM\HanayamaPPM is rare after AVR.pdfAnn.Thorac.Surg.1Knez20014Left ventricular architecture after valve replacement due to critical aortic stenosis: an approach to dis-/qualify the myth of valve prosthesis-patient mismatch?Journal4Left ventricular architecture after valve replacement due to critical aortic stenosis: an approach to dis-/qualify the myth of valve prosthesis-patient mismatch?Knez,I.Rienmuller,R.Maier,R.Rehak,P.Schrottner,B.Machler,H.nelli-Monti,M.Rigler,B.2001Agedanatomy & histologyAortic ValveAortic Valve StenosisBody Surface AreaCardiac OutputEchocardiographyFemaleHeart Valve ProsthesisHeart VentriclesHumansHypertrophyMalemethodsModels,TheoreticalpathologyphysiologyProspective StudiesResearch Support,Non-U.S.Gov'tsurgeryTimeVentricular Function,LeftNot in File797805Eur.J.Cardiothorac.Surg.19
Division of Cardiac Surgery, Karl Franzens University and Medical School of Graz, Graz, Austria. igor.knez@kfunigraz.ac.at
PM:11404133Eur.J.Cardiothorac.Surg.1Freed2002312Nineteen-millimeter prosthetic aortic valves allow normalization of left ventricular mass in elderly womenJournal312Nineteen-millimeter prosthetic aortic valves allow normalization of left ventricular mass in elderly womenFreed,D.H.Tam,J.W.Moon,M.C.Harding,G.E.Ahmad,E.Pascoe,E.A.2002AdultAgedAged,80 and overAortic ValveEchocardiographyFemaleHeart Valve DiseasesHeart Valve ProsthesisHemodynamic ProcessesHumansMalemethodsMiddle AgedmortalityProsthesis DesignsurgeryNot in File20222025Ann.Thorac.Surg.74
Section of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
PM:12643390Ann.Thorac.Surg.1Tasca200357Mass regression in aortic stenosis after valve replacement with small size pericardial bioprosthesisJournal57Mass regression in aortic stenosis after valve replacement with small size pericardial bioprosthesisTasca,G.Brunelli,F.Cirillo,M.Amaducci,A.Mhagna,Z.Troise,G.Quaini,E.2003Analysis of VarianceAortic Valve StenosisBioprosthesisChildChild,PreschoolEchocardiographyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHeart VentriclesHemodynamicsHumansMalemethodspathologyphysiologyphysiopathologyProsthesis DesignsurgeryultrasonographyNot in File11071113Ann.Thorac Surg76
Department of Cardiac Surgery, Hospital Poliambulanza, Brescia, Italy. cch-segreteria.poli@poliambulanza.it
PM:14529995Ann.Thorac Surg1(26;45;97;98). Bov and colleagues  ADDIN REFMGR.CITE Bove2006356Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcomeJournal356Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcomeBove,ThierryVan Belleghem,YvesFrancois,KatrienCaes,FrankVan Overbeke,HansVan Nooten,Guido2006Aortic ValveAortic valve replacementBioprosthesisLeft ventricular mass regressionmortalityStentless prosthesisNot in File706713European Journal of Cardio-Thoracic Surgery30http://www.sciencedirect.com/science/article/B6T35-4KTVP15-2/2/09c9b102ce9d4aa01b63f5d142005735European Journal of Cardio-Thoracic Surgery1(72) found the preexistence of advanced LVH to be a major obstacle for LVMR, despite otherwise successful AVR. The inference from these previous findings, although inconclusive, suggests that the presence of PPM would have a negative impact on the recovery of diastolic function. 1.8 Brain-type natriuretic peptide Natriuretic peptides are released by ventricular myocytes in response to pressure and volume overload that induces wall stress  ADDIN REFMGR.CITE Daniels2007100Natriuretic PeptidesJournal100Natriuretic PeptidesDaniels,Lori B.Maisel,Alan S.2007Not in File23572368Journal of the American College of Cardiology50http://www.sciencedirect.com/science/article/B6T18-4RCW571-5/2/652fc1b8f3d647fba77be6ef44cd99f1Journal of the American College of Cardiology1(99). The biologically active peptide brain-type natriuretic peptide (BNP) is cleaved from the inactive fragment NT-proBNP and released into the circulation where it exerts its vasodilative action and opposes the renin-angiotensin aldosterone system. Natriuretic peptides, especially BNP, have been established as an aid in recognizing symptoms of congestive heart failure and in discriminating between cardiac and non-cardiac dyspnea  ADDIN REFMGR.CITE Maisel2002142Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failureJournal142Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failureMaisel,A.S.Krishnaswamy,P.Nowak,R.M.McCord,J.Hollander,J.E.Duc,P.Omland,T.Storrow,A.B.Abraham,W.T.Wu,A.H.Clopton,P.Steg,P.G.Westheim,A.Knudsen,C.W.Perez,A.Kazanegra,R.Herrmann,H.C.McCullough,P.A.2002Acute DiseaseAgedanalysisAtrial Natriuretic FactorbloodclassificationcomplicationsDiabetes ComplicationsdiagnosisDiagnosis,DifferentialDyspneaetiologyFemaleHeart FailureHumansLogistic ModelsMalemethodsMiddle AgedMyocardial InfarctionNatriuretic Peptide,BrainProspective StudiesPulmonary Disease,Chronic ObstructiveSensitivity and SpecificityVentricular Dysfunction,LeftNot in File161167N Engl J Med347
University of California, San Diego, Veterans Affairs Medical Center, San Diego 92161, USA. amaisel@ucsd.edu
PM:12124404N Engl J Med1(100). BNP has also been reported to be an independent predictor of survival after acute coronary syndrome and ischemic heart failure in adult patients  ADDIN REFMGR.CITE Morrow2005106Prognostic Value of Serial B-Type Natriuretic Peptide Testing During Follow-up of Patients With Unstable Coronary Artery DiseaseJournal106Prognostic Value of Serial B-Type Natriuretic Peptide Testing During Follow-up of Patients With Unstable Coronary Artery DiseaseMorrow,David A.de Lemos,James A.Blazing,Michael A.Sabatine,Marc S.Murphy,Sabina A.Jarolim,PetrWhite,Harvey D.Fox,Keith A.A.Califf,Robert M.Braunwald,Eugenefor the,A.to2005Heart FailuremortalityNot in File28662871JAMA294http://jama.ama-assn.org/cgi/content/abstract/294/22/2866JAMA: The Journal of the American Medical AssociationJAMA1Masson2006111Direct comparison of B-type natriuretic peptide (BNP) and amino-terminal proBNP in a large population of patients with chronic and symptomatic heart failure: the Valsartan Heart Failure (Val-HeFT) dataJournal111Direct comparison of B-type natriuretic peptide (BNP) and amino-terminal proBNP in a large population of patients with chronic and symptomatic heart failure: the Valsartan Heart Failure (Val-HeFT) dataMasson,S.Latini,R.Anand,I.S.Vago,T.Angelici,L.Barlera,S.Missov,E.D.Clerico,A.Tognoni,G.Cohn,J.N.2006AgedBiological MarkersbloodCardiac Output,LowChronic DiseasediagnosisFemaleHeart FailureHumansLinear ModelsMalemethodsmortalityMulticenter Studies as TopicMultivariate AnalysisNatriuretic Peptide,BrainPeptide FragmentsphysiopathologyPredictive Value of TestsPrognosisRandomized Controlled Trials as TopicRoc CurveSeverity of Illness IndexNot in File15281538Clin.Chem.52
Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. masson@marionegri.it
PM:16777915Clin.Chem.1Woodard2007112Recent advances in natriuretic peptide researchJournal112Recent advances in natriuretic peptide researchWoodard,G.E.Rosado,J.A.2007diagnosisHeart FailurePrognosistherapeutic usetherapyNot in File12631271J.Cell Mol.Med.11
The National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
PM:18205700J.Cell Mol.Med.1de Lemos2001130The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromesJournal130The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromesde Lemos,J.A.Morrow,D.A.Bentley,J.H.Omland,T.Sabatine,M.S.McCabe,C.H.Hall,C.Cannon,C.P.Braunwald,E.2001Acute DiseaseAgedanalysisAngina,UnstableAtrial Natriuretic FactorbloodC-Reactive ProteincomplicationsetiologyFemaleHeart FailureHumansMalemethodsMiddle AgedmortalityMyocardial InfarctionNatriuretic Peptide,BrainOdds RatioPrognosisRandomized Controlled Trials as TopicRegression AnalysisRisk AssessmentStatistics,NonparametricNot in File10141021N.Engl.J.Med.345
Thrombolysis in Myocardial Infarction Study Group, Boston, USA. james.delemos@utsouthwestern.edu
PM:11586953N.Engl.J.Med.1(101-104). In aortic stenosis, plasma levels of natriuretic peptides are elevated  ADDIN REFMGR.CITE Prasad1997143Brain natriuretic peptide concentrations in patients with aortic stenosisJournal143Brain natriuretic peptide concentrations in patients with aortic stenosisPrasad,N.Bridges,A.B.Lang,C.C.Clarkson,P.B.MacLeod,C.Pringle,T.H.Struthers,A.D.MacDonald,T.M.1997AgedAortic stenosisAortic ValveAortic Valve StenosisAtrial Natriuretic FactorbloodCase-Control StudiesdiagnosisEchocardiography,DopplerFemaleHeart CatheterizationHeart Valve ProsthesisHumansMaleNatriuretic Peptide,BrainNerve Tissue ProteinsPredictive Value of TestssurgeryNot in File477479Am.Heart J133
Department of Cardiology, University of Dundee, United Kingdom
PM:9124176Am.Heart J1Qi2001144Natriuretic peptides in patients with aortic stenosisJournal144Natriuretic peptides in patients with aortic stenosisQi,W.Mathisen,P.Kjekshus,J.Simonsen,S.Bjornerheim,R.Endresen,K.Hall,C.2001AdultAgedAortic stenosisAortic Valve StenosisAtrial Function,LeftAtrial Natriuretic FactorBiological MarkersblooddiagnosisEchocardiographyFemaleHumansHypertrophy,Left VentricularMalemethodsMiddle AgedNatriuretic Peptide,BrainNatriuretic PeptidesNerve Tissue ProteinsPeptide FragmentsphysiologyProtein PrecursorsRoc CurveNot in File725732Am.Heart J142
Research Institute for Internal Medicine, the National Hospital, the University of Oslo, Norway. christian.hall@klinmed.uio.no
PM:11579366Am.Heart J1(105;106), and recent studies have established that BNP is related to the onset of symptoms  ADDIN REFMGR.CITE Bergler-Klein20046Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosisJournal6Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosisBergler-Klein,J.Klaar,U.Heger,M.Rosenhek,R.Mundigler,G.Gabriel,H.Binder,T.Pacher,R.Maurer,G.Baumgartner,H.2004AgedAged,80 and overanalysisAortic stenosisAortic ValveAortic Valve StenosisAtrial Natriuretic FactorBiological MarkersbloodcomplicationsDisease ProgressionDisease-Free SurvivalDyspneaetiologyFemaleHeart FailureHeart Valve Prosthesis ImplantationHumansLife TablesMalemethodsMiddle AgedmortalityMultivariate AnalysisNatriuretic Peptide,BrainNerve Tissue ProteinsPeptide FragmentsPrognosisProspective StudiesProtein PrecursorsSeverity of Illness IndexSingle-Blind Methodstatistics & numerical dataStroke VolumesurgerySurvivalTreatment OutcomeultrasonographyVentricular functionNot in File23022308Circulation109
Department of Cardiology and the Ludwig Boltzmann Institute of Cardiovascular Research, University of Vienna, Vienna, Austria
PM:15117847Circulation1Gerber2003122Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic StenosisJournal122Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic StenosisGerber,Ivor L.Stewart,Ralph A.H.Legget,Malcolm E.West,Teena M.French,Renelle L.Sutton,Timothy M.Yandle,Timothy G.French,John K.Richards,A.MarkWhite,Harvey D.2003Aortic stenosisAortic ValveEchocardiographymethodsNot in File18841890Circulation107http://circ.ahajournals.org/cgi/content/abstract/107/14/1884Circulation1(107;108), as well as the prognosis and outcome of severe asymptomatic AS  ADDIN REFMGR.CITE Bergler-Klein20046Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosisJournal6Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosisBergler-Klein,J.Klaar,U.Heger,M.Rosenhek,R.Mundigler,G.Gabriel,H.Binder,T.Pacher,R.Maurer,G.Baumgartner,H.2004AgedAged,80 and overanalysisAortic stenosisAortic ValveAortic Valve StenosisAtrial Natriuretic FactorBiological MarkersbloodcomplicationsDisease ProgressionDisease-Free SurvivalDyspneaetiologyFemaleHeart FailureHeart Valve Prosthesis ImplantationHumansLife TablesMalemethodsMiddle AgedmortalityMultivariate AnalysisNatriuretic Peptide,BrainNerve Tissue ProteinsPeptide FragmentsPrognosisProspective StudiesProtein PrecursorsSeverity of Illness IndexSingle-Blind Methodstatistics & numerical dataStroke VolumesurgerySurvivalTreatment OutcomeultrasonographyVentricular functionNot in File23022308Circulation109
Department of Cardiology and the Ludwig Boltzmann Institute of Cardiovascular Research, University of Vienna, Vienna, Austria
PM:15117847Circulation1Lim2004146Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptideJournal146Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptideLim,P.Monin,J.L.Monchi,M.Garot,J.Pasquet,A.Hittinger,L.Vanoverschelde,J.L.Carayon,A.Gueret,P.2004AgedAged,80 and overanalysisAortic stenosisAortic ValveAortic Valve StenosisbloodEchocardiographyEchocardiography,DopplerFemaleHumansMalemethodsMiddle AgedmortalityMultivariate AnalysisNatriuretic Peptide,BrainphysiologyphysiopathologyPrognosisRoc CurveSurvival AnalysisVentricular Dysfunction,LeftVentricular functionVentricular Function,LeftNot in File20482053Eur Heart J25
Department of Cardiology, Henri-Mondor Hospital, Creteil, Assistance Publique Hopitaux de Paris, 51 Avenue De Lattre De Tassigny, 94010 Creteil, France. lim.pascal@tiscali.fr
PM:15541842Eur Heart J1Weber2004147Relation of N-terminal pro-B-type natriuretic peptide to severity of valvular aortic stenosisJournal147Relation of N-terminal pro-B-type natriuretic peptide to severity of valvular aortic stenosisWeber,M.Arnold,R.Rau,M.Brandt,R.Berkovitsch,A.Mitrovic,V.Hamm,C.2004AgedAortic stenosisAortic ValveAortic Valve StenosisBiological MarkersbloodData Interpretation,StatisticaldiagnosisDisease ProgressionEchocardiographyFemaleHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedNatriuretic Peptide,BrainNerve Tissue ProteinsPeptide FragmentsProspective StudiesSeverity of Illness IndexsurgeryNot in File740745Am.J Cardiol.94
Kerckhoff Heart Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. m.weber@kerckhoff-klinik.de
PM:15374777Am.J Cardiol.1Weber2005148Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve diseaseJournal148Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve diseaseWeber,M.Arnold,R.Rau,M.Elsaesser,A.Brandt,R.Mitrovic,V.Hamm,C.2005/5AgedAortic stenosisAortic ValveAortic Valve InsufficiencyAortic Valve StenosisBiological MarkersbloodDisease ProgressionEchocardiographyFemaleHeart Valve Prosthesis ImplantationHumansLongitudinal StudiesMalemetabolismmethodsNatriuretic Peptide,BrainNerve Tissue ProteinsPeptide FragmentsPrognosisProspective StudiessurgerytherapyNot in File10231030Eur Heart J2610
Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. m.weber@kerckhoff-klinik.de
PM:15781428Eur Heart J1(107;109-111). 1.8.1 Preoperative measurement of brain-type natriuretic peptide in aortic valve stenosis In patients undergoing open heart surgery for different reasons, preoperative BNP or NT-proBNP has been shown to predict postoperative outcome with respect to perioperative and postoperative survival, postoperative hospital stay, necessity of intra-aortic balloon pump  ADDIN REFMGR.CITE Hutfless200498Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryJournal98Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryHutfless,R.Kazanegra,R.Madani,M.Bhalla,M.A.Tulua-Tata,A.Chen,A.Clopton,P.James,C.Chiu,A.Maisel,A.S.2004AgedbloodCardiac Surgical ProcedurescomplicationsHeart DiseasesHumansLength of StayMaleMiddle AgedmortalityNatriuretic Peptide,BrainPerioperative CarePostoperative ComplicationsPredictive Value of TestsRisk AssessmentsurgeryTreatment OutcomeNot in File18731879J.Am.Coll.Cardiol.43
University of California, San Diego, San Diego, California, USA
PM:15145114http://www.sciencedirect.com.ludwig.lub.lu.se/science?_ob=MImg&_imagekey=B6T18-4CCF2G1-W-9&_cdi=4884&_user=745831&_orig=search&_coverDate=05%2F19%2F2004&_sk=999569989&view=c&wchp=dGLbVlb-zSkWW&_valck=1&md5=21a385ff42398bbbc722df9cfdb1bae4&ie=/sdarticle.pdfJ.Am.Coll.Cardiol.1Provenchere20063Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortalityJournal3Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortalityProvenchere,S.Berroeta,C.Reynaud,C.Baron,G.Poirier,I.Desmonts,J.M.Iung,B.Dehoux,M.Philip,I.Benessiano,J.2006adverse effectsAgedanalysisbloodCardiac Surgical ProceduresCardiopulmonary BypassetiologyFemaleHeart DiseasesHumansMaleMiddle AgedmortalityMultivariate AnalysisNatriuretic Peptide,BrainPrognosisProspective StudiesRisk AssessmentsurgeryTime FactorsTroponinTroponin INot in File9951000Crit Care Med.34
Departement d'Anesthesie-Reanimation-Chirurgicale, Groupe Hospitalier Bichat-Claude Bernard (AP-HP), Faculte Xavier Bichat (Universite Paris 7), France
PM:16484891H:\Dokument\PEK III\ArtiklarCrit Care Med.1(112;113), and clinical improvement in patients with severe heart failure undergoing surgical ventricular restoration  ADDIN REFMGR.CITE Sartipy2007113Changes in B-type natriuretic peptides after surgical ventricular restorationJournal113Changes in B-type natriuretic peptides after surgical ventricular restorationSartipy,UlrikAlbage,AndersLarsson,Per ThomasInsulander,PerLindblom,Dan2007HeartHeart FailuremethodsmortalitysurgeryVentricular FunctionVentricular RemodelingNot in File922928European Journal of Cardio-Thoracic Surgery31http://ejcts.ctsnetjournals.org/cgi/content/abstract/31/5/922European Journal of Cardio-Thoracic Surgery1(114). In patients with LFLG aortic stenosis referred for valve replacement, those with high BNP levels had a worse outcome than those with lower BNP  ADDIN REFMGR.CITE Bergler-Klein2007103B-type natriuretic peptide in low-flow, low-gradient aortic stenosis: relationship to hemodynamics and clinical outcome: results from the Multicenter Truly or Pseudo-Severe Aortic Stenosis (TOPAS) studyJournal103B-type natriuretic peptide in low-flow, low-gradient aortic stenosis: relationship to hemodynamics and clinical outcome: results from the Multicenter Truly or Pseudo-Severe Aortic Stenosis (TOPAS) studyBergler-Klein,J.Mundigler,G.Pibarot,P.Burwash,I.G.Dumesnil,J.G.Blais,C.Fuchs,C.Mohty,D.Beanlands,R.S.Hachicha,Z.Walter-Publig,N.Rader,F.Baumgartner,H.2007AgedAged,80 and overAortic stenosisAortic Valve StenosisBlood PressureCardiac OutputCardiovascular AbnormalitiesChildclassificationcomplicationsdrug therapyepidemiologyHeart RateHumansMaleMiddle AgedNatriuretic AgentsNatriuretic Peptide,BrainphysiopathologySurvivaltherapeutic useVentricular Function,LeftNot in File28482855Circulation115
Department of Cardiology, Medical University of Vienna, Waehringer-Guertel 18-20, A-1090 Vienna, Austria. jutta.bergler-klein@meduniwien.ac.at
PM:17515464Circulation1(115). In a recent study of 144 patients with severe aortic stenosis referred for AVR, preoperative BNP was compared with the logistic EuroSCORE in an attempt to predict postoperative mortality  ADDIN REFMGR.CITE Pedrazzini2008155Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosisJournal155Comparison of brain natriuretic peptide plasma levels versus logistic EuroSCORE in predicting in-hospital and late postoperative mortality in patients undergoing aortic valve replacement for symptomatic aortic stenosisPedrazzini,G.B.Masson,S.Latini,R.Klersy,C.Rossi,M.G.Pasotti,E.Faletra,F.F.Siclari,F.Minervini,F.Moccetti,T.Auricchio,A.2008Age FactorsAgedanalysisAortic stenosisAortic ValveAortic Valve StenosisbloodCoronary Artery BypassCoronary Artery DiseaseFemaleFollow-Up StudiesHeart Valve ProsthesisHospital MortalityHumansMalemortalityNatriuretic Peptide,BrainOutcome Assessment (Health Care)Preoperative CareProspective StudiesSeverity of Illness IndexsurgeryNot in File749754Am J Cardiol102
Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
PM:18774001Am J Cardiol1(116). Patients with logistic EuroSCOREs greater than 10% had a higher mortality risk (hazard ratio (HR) 2.86), as had patients with a BNP level greater than 312 pg/mL (HR 9.01). Although many of these studies are limited by heterogeneous populations and a relatively small number of patients undergoing AVR, data indicate that preoperative measurement of BNP may be useful in risk stratification of patients, together with clinical findings and operative risk scores such as the EuroSCORE. 1.8.2 Measurement of brain-type natriuretic peptide following aortic valve replacement High BNP levels postoperatively may also predict mortality for patients undergoing open-heart surgery for different reasons  ADDIN REFMGR.CITE Hutfless200498Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryJournal98Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryHutfless,R.Kazanegra,R.Madani,M.Bhalla,M.A.Tulua-Tata,A.Chen,A.Clopton,P.James,C.Chiu,A.Maisel,A.S.2004AgedbloodCardiac Surgical ProcedurescomplicationsHeart DiseasesHumansLength of StayMaleMiddle AgedmortalityNatriuretic Peptide,BrainPerioperative CarePostoperative ComplicationsPredictive Value of TestsRisk AssessmentsurgeryTreatment OutcomeNot in File18731879J.Am.Coll.Cardiol.43
University of California, San Diego, San Diego, California, USA
PM:15145114http://www.sciencedirect.com.ludwig.lub.lu.se/science?_ob=MImg&_imagekey=B6T18-4CCF2G1-W-9&_cdi=4884&_user=745831&_orig=search&_coverDate=05%2F19%2F2004&_sk=999569989&view=c&wchp=dGLbVlb-zSkWW&_valck=1&md5=21a385ff42398bbbc722df9cfdb1bae4&ie=/sdarticle.pdfJ.Am.Coll.Cardiol.1(112). A few studies have previously examined the development of postoperative BNP after AVR due to aortic stenosis  ADDIN REFMGR.CITE Neverdal2006150The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis--one year follow-upJournal150The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis--one year follow-upNeverdal,N.O.Knudsen,C.W.Husebye,T.Vengen,O.A.Pepper,J.Lie,M.Tonnessen,T.2006AgedAortic stenosisAortic ValveAortic Valve StenosisbloodFemaleFollow-Up StudiesHumansHypertrophy,Left VentricularMalemethodsNatriuretic Peptide,BrainsurgeryNot in File257262Eur J Heart Fail8
Department of Cardiothoracic Surgery, Ulleval University Hospital, Oslo, Norway
PM:16466963Eur J Heart Fail1Qi2002156The effect of aortic valve replacement on N-terminal natriuretic propeptides in patients with aortic stenosisJournal156The effect of aortic valve replacement on N-terminal natriuretic propeptides in patients with aortic stenosisQi,W.Mathisen,P.Kjekshus,J.Simonsen,S.Endresen,K.Bjornerheim,R.Hall,C.2002AgedAortic stenosisAortic ValveAortic Valve StenosisAtrial Natriuretic FactorbloodFemaleHeart Valve Prosthesis ImplantationHumansHypertrophy,Left VentricularMalemethodsNatriuretic Peptide,BrainNatriuretic PeptidesphysiologyphysiopathologyPostoperative PeriodProtein PrecursorsPulmonary Wedge PressuresurgeryVentricular PressureNot in File174180Clin.Cardiol25
Institute for Internal Medicine and Department of Cardiology, The National Hospital, The University of Oslo, Norway
PM:12000075Clin.Cardiol1(117;118). In a study of 22 patients undergoing AVR  ADDIN REFMGR.CITE Neverdal2006150The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis--one year follow-upJournal150The effect of aortic valve replacement on plasma B-type natriuretic peptide in patients with severe aortic stenosis--one year follow-upNeverdal,N.O.Knudsen,C.W.Husebye,T.Vengen,O.A.Pepper,J.Lie,M.Tonnessen,T.2006AgedAortic stenosisAortic ValveAortic Valve StenosisbloodFemaleFollow-Up StudiesHumansHypertrophy,Left VentricularMalemethodsNatriuretic Peptide,BrainsurgeryNot in File257262Eur J Heart Fail8
Department of Cardiothoracic Surgery, Ulleval University Hospital, Oslo, Norway
PM:16466963Eur J Heart Fail1(117), transiently increased levels of BNP were seen immediately postoperatively and also when measured before hospital discharge. But after 6 and 12 months postoperatively, a significant decrease in BNP was observed. Persistently elevated BNP levels postoperatively indicated poor overall outcome late after AVR. In theory, BNP may remain elevated in patients with prosthesis-patient mismatch due to the residual transprosthetic gradient and increased LV myocardial wall pressure, although few data are available to date. In a previous study by Qi et al.  ADDIN REFMGR.CITE Qi2002156The effect of aortic valve replacement on N-terminal natriuretic propeptides in patients with aortic stenosisJournal156The effect of aortic valve replacement on N-terminal natriuretic propeptides in patients with aortic stenosisQi,W.Mathisen,P.Kjekshus,J.Simonsen,S.Endresen,K.Bjornerheim,R.Hall,C.2002AgedAortic stenosisAortic ValveAortic Valve StenosisAtrial Natriuretic FactorbloodFemaleHeart Valve Prosthesis ImplantationHumansHypertrophy,Left VentricularMalemethodsNatriuretic Peptide,BrainNatriuretic PeptidesphysiologyphysiopathologyPostoperative PeriodProtein PrecursorsPulmonary Wedge PressuresurgeryVentricular PressureNot in File174180Clin.Cardiol25
Institute for Internal Medicine and Department of Cardiology, The National Hospital, The University of Oslo, Norway
PM:12000075Clin.Cardiol1(118), patients with the largest EOAi (mean 1.27 cm2/m2) showed a considerable reduction in NT-proBNP, whereas patients with the smallest EOAi (mean 0.67 cm2/m2) showed no significant decrease in NT-proBNP following AVR. Furthermore, in a study by Weber et al.  ADDIN REFMGR.CITE Weber2005148Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve diseaseJournal148Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve diseaseWeber,M.Arnold,R.Rau,M.Elsaesser,A.Brandt,R.Mitrovic,V.Hamm,C.2005/5AgedAortic stenosisAortic ValveAortic Valve InsufficiencyAortic Valve StenosisBiological MarkersbloodDisease ProgressionEchocardiographyFemaleHeart Valve Prosthesis ImplantationHumansLongitudinal StudiesMalemetabolismmethodsNatriuretic Peptide,BrainNerve Tissue ProteinsPeptide FragmentsPrognosisProspective StudiessurgerytherapyNot in File10231030Eur Heart J2610
Department of Cardiology, Kerckhoff Heart Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. m.weber@kerckhoff-klinik.de
PM:15781428Eur Heart J1(119), a significant decrease in NT-proBNP was observed postoperatively, and this was associated with the type and size of the aortic prosthesis. Patients receiving a bioprosthesis had higher postoperative NT-proBNP levels than those receiving a mechanical prosthesis. Smaller prosthesis size was related to higher TPGs and a tendency towards higher NT-proBNP levels. The validation of postoperative BNP as a reliable biomarker to facilitate the diagnosis of heart failure following AVR may be useful in initiating and monitoring patient-tailored therapy in the ICU. However, the current evidence is not convincing, and further knowledge is required in this matter. 1.9 Aortic valve stenosis Aortic stenosis is the most prevalent valvular heart disease in the developed countries. Primarily a manifestation of ageing, the disorder is becoming more frequent as the average age of the population increases  ADDIN REFMGR.CITE Carabello20091Aortic stenosisJournal1Aortic stenosisCarabello,B.A.Paulus,W.J.2009AgingAngioplasty,Transluminal,Percutaneous CoronaryAortic Valve StenosisBiological MarkersCalcinosisCardiac OutputcomplicationsetiologyFemaleHeart CatheterizationHeart Valve ProsthesisHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMalepathologyPhysical ExaminationphysiopathologySurvival AnalysisSyncopetherapeutic usetherapyNot in File956966Lancet373
Baylor College of Medicine, Department of Medicine and Veterans Affairs Medical Center, Houston, TX, USA
PM:19232707Lancet1(120). The prevalence of aortic stenosis is 1-3% in the population older than 65 years and around 4% in that older than 85 years. Age-related degenerative calcification is currently the most common cause of aortic stenosis in adults and the most frequent reason for AVR  ADDIN REFMGR.CITE Freeman20052Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategiesJournal2Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategiesFreeman,R.V.Otto,C.M.2005Aortic ValveAortic Valve StenosisCalcinosisdiagnosisDisease ProgressionetiologyHeart Valve DiseasesHumansInflammationpathologyRisk FactorsSclerosisNot in File33163326Circulation111
Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash 98195-6422, USA. rosariof@u.washington.edu
PM:15967862Circulation1(121). 1.9.1 Pathophysiology Aortic stenosis is characterized by a progressive obstruction of the left ventricular outflow tract. Narrowing of the aortic orifice to half its usual size, 3-4 cm, causes little obstruction and only a small pressure gradient across the valve. Progression of the stenosis causes the LV to adapt to the systolic pressure overload through a hypertrophic process that results in increased LV wall thickness, while a normal chamber volume is maintained  ADDIN REFMGR.CITE Carabello20091Aortic stenosisJournal1Aortic stenosisCarabello,B.A.Paulus,W.J.2009AgingAngioplasty,Transluminal,Percutaneous CoronaryAortic Valve StenosisBiological MarkersCalcinosisCardiac OutputcomplicationsetiologyFemaleHeart CatheterizationHeart Valve ProsthesisHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMalepathologyPhysical ExaminationphysiopathologySurvival AnalysisSyncopetherapeutic usetherapyNot in File956966Lancet373
Baylor College of Medicine, Department of Medicine and Veterans Affairs Medical Center, Houston, TX, USA
PM:19232707Lancet1Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(63;120). The resulting increase in relative wall thickness is usually sufficient to counter the high intracavitary systolic pressure, and as a result, LV systolic wall stress (afterload) remains within the normal range. As long as wall stress is normal, the ejection fraction is preserved  ADDIN REFMGR.CITE Krayenbuehl198861Left ventricular systolic function in aortic stenosisJournal61Left ventricular systolic function in aortic stenosisKrayenbuehl,H.P.Hess,O.M.Ritter,M.Monrad,E.S.Hoppeler,H.1988Aortic ValveAortic Valve StenosisCardiomegalyHeartHeart Valve ProsthesisHumanspathologyphysiopathologyStroke VolumesurgerySystoleNot in File1923Eur Heart J9 Suppl E
Division of Cardiology, University Hospital, Zurich, Switzerland
PM:2969811European Heart JournalEur Heart J1(122). The compensated phase of aortic stenosis, with progressive LVH, may cause the patient to be asymptomatic for decades. However, if the hypertrophic process is inadequate and the thickness of the wall does not increase in proportion to the pressure, the wall stress will increase and the high afterload will cause a decrease in ejection fraction  ADDIN REFMGR.CITE Krayenbuehl198861Left ventricular systolic function in aortic stenosisJournal61Left ventricular systolic function in aortic stenosisKrayenbuehl,H.P.Hess,O.M.Ritter,M.Monrad,E.S.Hoppeler,H.1988Aortic ValveAortic Valve StenosisCardiomegalyHeartHeart Valve ProsthesisHumanspathologyphysiopathologyStroke VolumesurgerySystoleNot in File1923Eur Heart J9 Suppl E
Division of Cardiology, University Hospital, Zurich, Switzerland
PM:2969811European Heart JournalEur Heart J1Ross197663Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular functionJournal63Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular functionRoss,J.,Jr.1976AnimalsAortaBlood PressureCardiac OutputCardiac VolumeCardiomegalyetiologyHeartHeart DiseasesHeart Function TestsHeart VentriclesHumansmethodsMyocardial ContractionphysiopathologytherapyTime FactorsVentricular FunctionNot in File255264Prog.Cardiovasc Dis.18PM:128034Prog.Cardiovasc Dis.1Gunther197964Determinants of ventricular function in pressure-overload hypertrophy in manJournal64Determinants of ventricular function in pressure-overload hypertrophy in manGunther,S.Grossman,W.1979AdultAgedAngiographyAortic Valve StenosisBlood PressureCardiomegalyCineangiographyElectrocardiographyFemaleHeart VentriclesHemodynamicsHumansMaleMiddle AgedphysiopathologyStress,PhysiologicalVentricular FunctionNot in File679688Circulation59PM:154367Circulation1(122-124). Although hypertrophy helps to preserve LV systolic performance, the increased wall thickness impairs coronary blood flow reserve thereby impairing diastolic function. Therefore, the hypertrophied heart may have reduced coronary blood flow per gram of muscle and also exhibit a limited coronary vasodilator reserve, even in the absence of epicardial coronary artery disease  ADDIN REFMGR.CITE Carabello200216Clinical practice. Aortic stenosisJournal16Clinical practice. Aortic stenosisCarabello,B.A.2002Algorithmsanatomy & histologyAortic ValveAortic Valve StenosisdiagnosisHeart Valve ProsthesisHumansMaleMiddle AgedphysiopathologyPractice Guidelines as TopicPrognosisStroke VolumetherapyNot in File677682N Engl J Med346
Department of Medicine, Baylor College of Medicine, and the Veterans Affairs Medical Center, Houston, TX 77030, USA. blaseanthony.carabello@med.va.gov
PM:11870246The New England Journal of MedicineN Engl J Med1Marcus198265Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteriesJournal65Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteriesMarcus,M.L.Doty,D.B.Hiratzka,L.F.Wright,C.B.Eastham,C.L.1982AgedAngina PectorisAortic Valve StenosisbloodBlood Flow VelocityCardiomegalycomplicationsCoronary CirculationEchocardiographyetiologyFemaleHumansMaleMiddle AgedphysiopathologysurgeryultrasonographyNot in File13621366N Engl J Med307PM:6215582The New England Journal of MedicineN Engl J Med1(125;126). The hemodynamic stress of exercise or tachycardia can produce a maldistribution of coronary blood flow and subendocardial ischemia, which can contribute to systolic or diastolic dysfunction of the left ventricle. The increased wall thickness leads to a diminished compliance of the chamber, and the LV end-diastolic pressure increases without chamber dilatation  ADDIN REFMGR.CITE Gaasch197666Left ventricular compliance: mechanisms and clinical implicationsJournal66Left ventricular compliance: mechanisms and clinical implicationsGaasch,W.H.Levine,H.J.Quinones,M.A.Alexander,J.K.1976Angina PectorisAortic Valve InsufficiencyBlood PressureCardiac OutputCardiac VolumeCardiomegalyComplianceCoronary Diseasedrug effectsHeartHeart VentriclesHumansMitral Valve StenosisMuscle RigidityMyocardial ContractionMyocardial InfarctionNitroglycerinpharmacologyphysiopathologyTensile StrengthNot in File645653Am.J Cardiol.38PM:136186Am.J Cardiol.1Hess198414Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacementJournal14Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacementHess,O.M.Ritter,M.Schneider,J.Grimm,J.Turina,M.Krayenbuehl,H.P.1984AdultAortic ValveCardiomegalyCineangiographyDiastoleFemaleHeartHeart CatheterizationHeart Valve DiseasesHeart Valve ProsthesisHeart VentriclesHemodynamicsHumansMaleMiddle AgedMyocardiumpathologyphysiopathologysurgeryNot in File855865Circulation69PM:6231136Circulation1Murakami198667Diastolic filling dynamics in patients with aortic stenosisJournal67Diastolic filling dynamics in patients with aortic stenosisMurakami,T.Hess,O.M.Gage,J.E.Grimm,J.Krayenbuehl,H.P.1986AdultAgedAortic Valve StenosisCardiomegalyCineangiographyDiastoleFemaleHeart CatheterizationHeart VentriclesHumansMaleMiddle AgedMitral ValveMyocardial ContractionphysiopathologyPostoperative PeriodPreoperative CareStroke VolumesurgeryNot in File11621174Circulation73PM:2938847Circulation1(127-129). Thus, increased end-diastolic pressure usually reflects diastolic dysfunction rather than systolic dysfunction or failure  ADDIN REFMGR.CITE Gaasch199469Diagnosis and treatment of heart failure based on left ventricular systolic or diastolic dysfunctionJournal69Diagnosis and treatment of heart failure based on left ventricular systolic or diastolic dysfunctionGaasch,W.H.1994classificationdiagnosisDiastoleHeartHeart FailureHumansmortalityphysiologyphysiopathologyPrognosisSystoletherapyVentricular Function,LeftNot in File12761280JAMA271
Department of Medicine, University of Massachusetts Medical School, Worcester
PM:8151903JAMA: The Journal of the American Medical AssociationJAMA1(130). This state of impaired LV diastolic dysfunction in aortic stenosis has been demonstrated to be associated with increased mortality  ADDIN REFMGR.CITE Rajappan20034Functional Changes in Coronary Microcirculation After Valve Replacement in Patients With Aortic StenosisJournal4Functional Changes in Coronary Microcirculation After Valve Replacement in Patients With Aortic StenosisRajappan,KimRimoldi,Ornella E.Camici,Paolo G.Bellenger,Nicholas G.Pennell,Dudley J.Sheridan,Desmond J.2003Aortic ValveNot in File31703175Circulation107http://circ.ahajournals.org/cgi/content/abstract/107/25/3170Circulation1Gould20035Why Angina in Aortic Stenosis With Normal Coronary Arteriograms?Journal5Why Angina in Aortic Stenosis With Normal Coronary Arteriograms?Gould,K.LanceCarabello,Blase A.2003Not in File31213123Circulation107http://circ.ahajournals.orgCirculation1Zile20026New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part II: Causal Mechanisms and TreatmentJournal6New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part II: Causal Mechanisms and TreatmentZile,Michael R.Brutsaert,Dirk L.2002Not in File15031508Circulation105http://circ.ahajournals.orgCirculation1(33;131;132). The survival of asymptomatic patients is similar to that of an age- and gender-matched healthy population; however, the prognosis worsens significantly as soon as symptoms develop. The onset of severe symptoms of aortic stenosisangina, syncope, and heart failureremains the major demarcation point in the course of the disease at which most patients are referred for AVR  ADDIN REFMGR.CITE Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1Carabello20091Aortic stenosisJournal1Aortic stenosisCarabello,B.A.Paulus,W.J.2009AgingAngioplasty,Transluminal,Percutaneous CoronaryAortic Valve StenosisBiological MarkersCalcinosisCardiac OutputcomplicationsetiologyFemaleHeart CatheterizationHeart Valve ProsthesisHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMalepathologyPhysical ExaminationphysiopathologySurvival AnalysisSyncopetherapeutic usetherapyNot in File956966Lancet373
Baylor College of Medicine, Department of Medicine and Veterans Affairs Medical Center, Houston, TX, USA
PM:19232707Lancet1Dal-Bianco200862Management of asymptomatic severe aortic stenosisJournal62Management of asymptomatic severe aortic stenosisDal-Bianco,J.P.Khandheria,B.K.Mookadam,F.Gentile,F.Sengupta,P.P.2008AgedAngioplasty,BalloonAortic ValveAortic Valve StenosisCardiovascular DiseasesdiagnosisEchocardiographyEchocardiography,DopplerElectrocardiographyExerciseExercise TestFemaleHeart Valve Prosthesis ImplantationHumansMagnetic Resonance ImagingMalemethodsmortalityPostoperative ComplicationsPredictive Value of TestsPrognosisRandomized Controlled Trials as TopicRisk AssessmentSeverity of Illness IndexStroke VolumesurgerySurvival AnalysistherapyNot in File12791292J Am.Coll.Cardiol.52
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
PM:18929238J Am.Coll.Cardiol.1(63;120;133). 1.10 Aortic valve insufficiency There are a number of common causes of AVI including idiopathic dilatation of the aorta, congenital abnormalities of the aortic valve (most notably bicuspid valves), calcific degeneration, rheumatic disease, infective endocarditis, myxomatous degeneration, dissection of the ascending aorta, and Marfan syndrome. The majority of these lesions produce chronic aortic insufficiency with slow, insidious LV dilation and a prolonged asymptomatic phase  ADDIN REFMGR.CITE Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(63). Other lesions, in particular infective endocarditis, aortic dissection, and trauma, more often produce acute severe AVI, which can result in sudden catastrophic elevation of LV filling pressures and reduction in cardiac output. 1.10.1 Acute aortic valve insufficiency Acute AVI is by definition a hemodynamically significant aortic incompetence with sudden onset across a previously competent aortic valve into a left ventricle not previously subjected to volume overload. The inability to adapt is worse for concentrically thickened hypertrophic myocardium typically seen in those with chronic hypertension. Effective cardiac output is less than that of the chronic state because compensatory dilatation has not occurred, and, hence, LV end-diastolic volume remains larger than normal but small in comparison with effective stroke volume. Compensatory changes in heart rate occur, higher than those of chronic AR, to augment cardiac output. Overall, the hemodynamic effects of acute AVI produce a low effective cardiac output with an elevated LV diastolic pressure and heart rate. Any changes in diastolic filling or heart rate, which are maintained in a delicate balance, lead to the onset of congestive heart failure, and patients frequently present with pulmonary edema or cardiogenic shock  ADDIN REFMGR.CITE Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(63). 1.10.2 Chronic aortic valve insufficiency Chronic AVI is a slow and insidious process, which sets in motion numerous compensatory mechanisms. The left ventricle accommodates increased volume and pressure caused by the regurgitant flow by eccentric ventricular hypertrophy, with a consecutive increase in LV end-diastolic volumes. Cardiac output is maintained with the aid of the autonomic nervous system. AVI also impairs early diastolic function because eccentric hypertrophy leads to impaired LV relaxation during later stages of the disease process  ADDIN REFMGR.CITE Rousseau198270Assessment of left ventricular relaxation in patients with valvular regurgitationJournal70Assessment of left ventricular relaxation in patients with valvular regurgitationRousseau,M.F.Pouleur,H.Charlier,A.A.Brasseur,L.A.1982AdultAgedAortic Valve InsufficiencyCineangiographydiagnosisdrug effectsFemaleHeart CatheterizationHeart VentriclesHumansMaleMiddle AgedMitral Valve InsufficiencyMyocardial ContractionNifedipinepharmacologyphysiopathologyStroke VolumeNot in File10281036Am.J Cardiol.50PM:7137028Am.J Cardiol.1(134). The greater diastolic volume permits the ventricle to eject a large total stroke volume to maintain forward stroke volume in the normal range. This is accomplished through rearrangement of myocardial fibers with the addition of new sarcomeres and development of eccentric LV hypertrophy. Although the LVEF remains in the normal range, the enlarged chamber size, with the associated increase in systolic wall stress, also results in an increase in LV afterload and is a stimulus for further hypertrophy  ADDIN REFMGR.CITE Grossman197571Wall stress and patterns of hypertrophy in the human left ventricleJournal71Wall stress and patterns of hypertrophy in the human left ventricleGrossman,W.Jones,D.McLaurin,L.P.1975AdolescentAdultAngiocardiographyCardiac OutputCardiomegalyElectrocardiographyetiologyFemaleHeartHeart CatheterizationHeart VentriclesHemodynamicsHumansMaleMiddle AgedMyocardial ContractionphysiopathologyPressureStress,MechanicalultrasonographyNot in File5664J Clin.Invest56PM:124746J Clin.Invest1Wisenbaugh198472Differences in myocardial performance and load between patients with similar amounts of chronic aortic versus chronic mitral regurgitationJournal72Differences in myocardial performance and load between patients with similar amounts of chronic aortic versus chronic mitral regurgitationWisenbaugh,T.Spann,J.F.Carabello,B.A.1984Acute DiseaseAdultAgedAortic Valve InsufficiencyChronic DiseaseFemaleHeartHemodynamicsHumansMaleMiddle AgedMitral Valve InsufficiencyMyocardial ContractionphysiopathologyNot in File916923J Am.Coll.Cardiol.3PM:6707357J Am.Coll.Cardiol.1(135;136). As the disease progresses, compensatory hypertrophy permit the ventricle to maintain normal ejection performance despite the elevated afterload  ADDIN REFMGR.CITE Ricci198273Afterload mismatch and preload reserve in chronic aortic regurgitationJournal73Afterload mismatch and preload reserve in chronic aortic regurgitationRicci,D.R.1982AdolescentAdultAortic Valve InsufficiencyCardiomegalyChronic DiseasediagnosisHeart CatheterizationHeart VentriclesHumansMiddle AgedphysiopathologyStroke VolumeSystoleNot in File826834Circulation66PM:6214335Circulation1Ross198574Afterload mismatch in aortic and mitral valve disease: implications for surgical therapyJournal74Afterload mismatch in aortic and mitral valve disease: implications for surgical therapyRoss,J.,Jr.1985AnimalsAortaAortic ValveAortic Valve InsufficiencyAortic Valve StenosisBody Surface AreaCardiac OutputChronic DiseaseDogsEchocardiographyetiologyHeartHeart CatheterizationHeart Valve ProsthesisHeart VentriclesHumansMitral ValveMitral Valve InsufficiencyphysiopathologyPostoperative ComplicationsPostoperative PeriodStroke VolumesurgerySystoletherapyVentricular FunctionNot in File811826J Am.Coll.Cardiol.5PM:3882814J Am.Coll.Cardiol.1(137;138). The majority of patients remain asymptomatic throughout this compensated phase, which may last for decades. Eventually, the balance between afterload excess and hypertrophy cannot be maintained and further increases in afterload result in a reduction in LVEF. Patients often develop dyspnea at this point in the natural history. In addition, diminished coronary flow reserve in the hypertrophied myocardium may result in exertional angina  ADDIN REFMGR.CITE Nitenberg198875Coronary flow and resistance reserve in patients with chronic aortic regurgitation, angina pectoris and normal coronary arteriesJournal75Coronary flow and resistance reserve in patients with chronic aortic regurgitation, angina pectoris and normal coronary arteriesNitenberg,A.Foult,J.M.Antony,I.Blanchet,F.Rahali,M.1988AdultAgedAngina PectorisAortic Valve InsufficiencybloodChronic DiseaseCoronary CirculationCoronary VesselsDipyridamoledrug effectsdrug therapyFemaleHeart CatheterizationHemodynamicsHumansMaleMiddle Agedpharmacologyphysiopathologytherapeutic useVascular ResistanceNot in File478486J Am.Coll.Cardiol.11
Laboratoire d'Hemodynamique et d'Angiocardiographie, INSERM U.251, CHU Xavier Bichat, Paris, France
PM:3278034J Am.Coll.Cardiol.1(139). However, this transition may be much more insidious, and it is possible for patients to remain asymptomatic until severe LV dysfunction has developed. LV systolic dysfunction is initially a reversible phenomenon related predominantly to afterload excess, and full recovery of LV size and function is possible with AVR  ADDIN REFMGR.CITE Borer199176Natural history of left ventricular performance at rest and during exercise after aortic valve replacement for aortic regurgitationJournal76Natural history of left ventricular performance at rest and during exercise after aortic valve replacement for aortic regurgitationBorer,J.S.Herrold,E.M.Hochreiter,C.Roman,M.Supino,P.Devereux,R.B.Kligfield,P.Nawaz,H.1991Aortic ValveAortic Valve InsufficiencyCineangiographyepidemiologyExerciseFollow-Up StudiesHeartHeart Valve ProsthesisHumansphysiologyphysiopathologyRadionuclide Angiographyradionuclide imagingsurgeryTime FactorsVentricular Function,LeftNot in FileIII133III139Circulation84
Cardiology Division, New York Hospital-Cornell Medical Center, NY 10021
PM:1934401Circulation1Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(63;140). With time, during which the ventricle develops progressive chamber enlargement and a more spherical geometry, depressed myocardial contractility predominates over excessive loading as the cause of progressive systolic dysfunction. This can progress to the extent that the full benefit of surgical correction of the regurgitant lesion, in terms of recovery of LV function and improved survival, can no longer be achieved  ADDIN REFMGR.CITE Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(63). 1.11 Aortic valve replacement The introduction of valve replacement surgery in the early 1960s has dramatically improved the outcome of patients with valvular heart disease. Approximately 280000 valve substitutes are now implanted worldwide each year; approximately half of which are mechanical valves and half are bioprosthetic valves  ADDIN REFMGR.CITE Pibarot200966Prosthetic heart valves: selection of the optimal prosthesis and long-term managementJournal66Prosthetic heart valves: selection of the optimal prosthesis and long-term managementPibarot,P.Dumesnil,J.G.2009Not in File10341048Circulation119
Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V-4G5. philippe.pibarot@med.ulaval.ca or medjgd@hermes.ulaval.ca
PM:19237674Circulation1(38). Despite the marked improvements in prosthetic valve design and surgical procedures over the past decades, valve replacement does not provide a definitive cure to the patient. Instead, native valve disease is traded for prosthetic valve disease, and the outcome of patients undergoing valve replacement is affected by prosthetic valve hemodynamics, durability, and thrombogenicity. Nonetheless, many of the prosthesis-related complications can be prevented or their impact minimized through optimal prosthesis selection in the individual patient and careful medical management and follow-up after implantation. The average surgical mortality for isolated AVR is approximately 3% to 4%  ADDIN REFMGR.CITE Iung200396A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart DiseaseJournal96A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart DiseaseIung,B.Baron,G.Butchart,E.G.Delahaye,F.Gohlke-Barwolf,C.Levang,O.W.Tornos,P.Vanoverschelde,J.L.Vermeer,F.Boersma,E.Ravaud,P.Vahanian,A.2003AdultAngiographyComorbidityEndocarditisHeartmortalityNot in File12311243Eur Heart J240195668xEuropean Heart JournalEur Heart J1(141) and 1% to 2% in high-volume and experienced medical centers  ADDIN REFMGR.CITE Bonow20065ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal5ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Kanu,C.de Leon,A.C.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Faxon,D.P.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006Not in Filee84e231Circulation11410.1161/CIRCULATIONAHA.106.176857Circulation1(142). Surgical mortality, however, increases progressively with age and is up to 9% in octogenarians  ADDIN REFMGR.CITE Kolh200797Aortic valve surgery in octogenarians: predictive factors for operative and long-term resultsJournal97Aortic valve surgery in octogenarians: predictive factors for operative and long-term resultsKolh,P.Kerzmann,A.Honore,C.Comte,L.Limet,R.2007Aortic ValveArteriescomplicationsCoronary Artery BypassFemaleHeartmethodsMorbiditymortalityMyocardial InfarctionPostoperative ComplicationssurgeryNot in File600606European Journal of Cardio-Thoracic Surgery3110107940European Journal of Cardio-Thoracic Surgery1Thourani200898Long-Term Outcomes After Isolated Aortic Valve Replacement in Octogenarians: A Modern PerspectiveJournal98Long-Term Outcomes After Isolated Aortic Valve Replacement in Octogenarians: A Modern PerspectiveThourani,V.H.Myung,R.Kilgo,P.Thompson,K.Puskas,J.D.Lattouf,O.M.Cooper,W.A.Vega,J.D.Chen,E.P.Guyton,R.A.2008Analysis of VarianceAortic ValveLength of StaymethodsmortalityOdds RatioSurvival RatetherapyNot in File14581465Ann Thorac Surg8600034975The Annals of Thoracic SurgeryAnn Thorac Surg1(143;144). Additional factors can further increase the risk of operative mortality in asymptomatic severe AS, including emergent surgery, LV dysfunction, pulmonary hypertension, coexisting coronary artery disease, and previous open-heart surgery  ADDIN REFMGR.CITE Dal-Bianco200862Management of asymptomatic severe aortic stenosisJournal62Management of asymptomatic severe aortic stenosisDal-Bianco,J.P.Khandheria,B.K.Mookadam,F.Gentile,F.Sengupta,P.P.2008AgedAngioplasty,BalloonAortic ValveAortic Valve StenosisCardiovascular DiseasesdiagnosisEchocardiographyEchocardiography,DopplerElectrocardiographyExerciseExercise TestFemaleHeart Valve Prosthesis ImplantationHumansMagnetic Resonance ImagingMalemethodsmortalityPostoperative ComplicationsPredictive Value of TestsPrognosisRandomized Controlled Trials as TopicRisk AssessmentSeverity of Illness IndexStroke VolumesurgerySurvival AnalysistherapyNot in File12791292J Am.Coll.Cardiol.52
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
PM:18929238J Am.Coll.Cardiol.1(133). According to the ACC/AHA guidelines, the choice of prosthesis type should depend on anticoagulation contraindications, risk of thrombosis, concurrent mitral or tricuspid mechanical valve and patient preferences  ADDIN REFMGR.CITE Bonow20065ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal5ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Kanu,C.de Leon,A.C.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Faxon,D.P.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006Not in Filee84e231Circulation11410.1161/CIRCULATIONAHA.106.176857Circulation1(142). One should contemplate the prosthesis models that have a well-established track record with regard to long-term durability and low thrombogenicity. Mechanical aortic valves have an estimated average rate of major thromboembolism of 4 to 8 per 100 patient-years in patients not receiving long-term anticoagulation therapy  ADDIN REFMGR.CITE Kulik200699Early Postoperative Anticoagulation After Mechanical Valve Replacement: A Systematic ReviewJournal99Early Postoperative Anticoagulation After Mechanical Valve Replacement: A Systematic ReviewKulik,A.Rubens,F.D.Wells,P.S.Kearon,C.Mesana,T.G.van Berkom,J.Lam,B.K.2006bloodcomplicationsHemodynamicsIncidencemortalitysurgeryNot in File770781Ann Thorac Surg8100034975The Annals of Thoracic SurgeryAnn Thorac Surg1(145). This risk is reduced to 2.2 per 100 patient-years with anti-platelet therapy, and further reduced to 1 per 100 patient-years with oral anticoagulation (warfarin). The incidence of bleeding related to anticoagulation therapy is 4.6 per 100 patient-years  ADDIN REFMGR.CITE Cannegieter1994100Thromboembolic and Bleeding Complications in Patients With Mechanical Heart Valve ProsthesesJournal100Thromboembolic and Bleeding Complications in Patients With Mechanical Heart Valve ProsthesesCannegieter,S.Rosendaal,F.Briet,E.1994complicationsHeartRisktherapyNot in File635641Circulation (New York, N.Y.)8900097322Circulation (New York, N.Y.)1(146), increasing significantly when patients are e"75 years of age  ADDIN REFMGR.CITE <Refman><Cite><Author>Dal-Bianco</Author><Year>2008</Year><RecNum>62</RecNum><IDText>Management of asymptomatic severe aortic stenosis</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>62</Ref_ID><Title_Primary>Management of asymptomatic severe aortic stenosisDal-Bianco,J.P.Khandheria,B.K.Mookadam,F.Gentile,F.Sengupta,P.P.2008AgedAngioplasty,BalloonAortic ValveAortic Valve StenosisCardiovascular DiseasesdiagnosisEchocardiographyEchocardiography,DopplerElectrocardiographyExerciseExercise TestFemaleHeart Valve Prosthesis ImplantationHumansMagnetic Resonance ImagingMalemethodsmortalityPostoperative ComplicationsPredictive Value of TestsPrognosisRandomized Controlled Trials as TopicRisk AssessmentSeverity of Illness IndexStroke VolumesurgerySurvival AnalysistherapyNot in File12791292J Am.Coll.Cardiol.52
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
PM:18929238J Am.Coll.Cardiol.1(133). Prosthetic valve endocarditis is an uncommon but potentially lethal complication of heart valve replacement surgery associated with substantial morbidity and mortality. Prosthetic valve endocarditis has been estimated to occur at a rate of 0.3% to 1% per patient-year and to account for 1% to 5% of all cases of infective endocarditis  ADDIN REFMGR.CITE Wang2007101Contemporary Clinical Profile and Outcome of Prosthetic Valve EndocarditisJournal101Contemporary Clinical Profile and Outcome of Prosthetic Valve EndocarditisWang,AndrewAthan,EugenePappas,Paul A.Fowler,Vance G.,Jr.Olaison,LarsPare,CarlosAlmirante,BenitoMunoz,PatriciaRizzi,MarcoNaber,ChristophLogar,MatejaTattevin,PierreIarussi,Diana L.Selton-Suty,ChristineJones,Sandra BraunCasabe,JoseMorris,ArthurCorey,G.RalphCabell,Christopher H.for the International Collaboration on Endocarditis-Prospective Cohort Study Investigators,2007complicationsdiagnosisEndocarditisHeartHeart FailureMorbiditymortalityOdds RatiosurgeryNot in File13541361JAMA297http://jama.ama-assn.org/cgi/content/abstract/297/12/1354JAMA: The Journal of the American Medical AssociationJAMA1(147). Bioprosthetic aortic valves have the main risk of structural valve degeneration and therefore reduced valve durability, although in a recent meta-analysis, Lund and colleagues  ADDIN REFMGR.CITE Lund2006102Risk-corrected impact of mechanical versus bioprosthetic valves on long-term mortality after aortic valve replacementJournal102Risk-corrected impact of mechanical versus bioprosthetic valves on long-term mortality after aortic valve replacementLund,O.Bland,M.2006AdultAortic ValveArteriescomplicationsCoronary Artery BypassEndocarditisHeartIncidencemethodsMiddle AgedmortalityRiskRisk FactorsNot in File2026Journal of thoracic and cardiovascular surgery13200225223Journal of thoracic and cardiovascular surgery1(148) did not find any differences in mortality between patients with mechanical aortic valves and those with bioprosthetic aortic valves. A bioprosthetic aortic valve is currently a reasonable choice in adult patients (65-70 years of age) who decline, do not require or have contraindications to anticoagulation therapy  ADDIN REFMGR.CITE Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(63). The choice of a prosthesis that may provide superior hemodynamic performance, thus preventing PPM, is suggested to be the next step in achieving a patient-tailored prosthesis. This may be achieved by selecting the model that provides the largest valve EOA in relation to the patients annulus size. Stent design for bioprostheses has evolved during the past years towards lower profiles and thinner sewing rings striving to match the hemodynamic and functional characteristics of the native aortic valve  ADDIN REFMGR.CITE Pibarot200966Prosthetic heart valves: selection of the optimal prosthesis and long-term managementJournal66Prosthetic heart valves: selection of the optimal prosthesis and long-term managementPibarot,P.Dumesnil,J.G.2009Not in File10341048Circulation119
Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V-4G5. philippe.pibarot@med.ulaval.ca or medjgd@hermes.ulaval.ca
PM:19237674Circulation1(38). However, despite progress in the construction and design of bioprostheses, parts of the sewing ring and stent construction are positioned within the aortic outflow tract, causing a degree of blood flow obstruction. The hemodynamic performance is generally superior in newer than in older generations of prostheses, in mechanical than in stented bioprosthetic valves  ADDIN REFMGR.CITE Bech-Hanssen199955Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosisJournal55Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosisBech-Hanssen,O.Caidahl,K.Wall,B.Myken,P.Larsson,S.Wallentin,I.1999adverse effectsAgedAortic ValveAortic Valve StenosisCardiac OutputclassificationcomplicationsDiastoleDyspneaEchocardiographyetiologyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansHypertrophy,Left VentricularinstrumentationLinear ModelsMalemethodsphysiologyphysiopathologyPrognosisProsthesis DesignStentsStroke VolumesurgerySystoleTreatment OutcomeultrasonographyVentricular Function,LeftNot in File5765J Thorac Cardiovasc Surg118
Departments of Clinical Physiology and Thoracic and Cardiovascular Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
PM:10384185J Thorac Cardiovasc Surg1(149), and in stentless than in stented prostheses. In a meta-analysis, Kunadian et al.  ADDIN REFMGR.CITE Kunadian2007103Meta-Analysis of Valve Hemodynamics and Left Ventricular Mass Regression for Stentless Versus Stented Aortic ValvesJournal103Meta-Analysis of Valve Hemodynamics and Left Ventricular Mass Regression for Stentless Versus Stented Aortic ValvesKunadian,B.Vijayalakshmi,K.Thornley,A.R.de Belder,M.A.Hunter,S.Kendall,S.Graham,R.Stewart,M.Thambyrajah,J.Dunning,J.2007Aortic ValveHemodynamicsmethodsNot in File7378Ann Thorac Surg8400034975The Annals of Thoracic SurgeryAnn Thorac Surg1(76) concluded that stentless aortic valves provide an improved level of LVMR, reduced gradients, and an improved EOAi, but longer cross-clamp and cardiopulmonary by-pass times are required. In contrast, stentless valves did not show any hemodynamic benefit in terms of LVMR or postoperative mean gradients in a different meta-analysis by Payne and colleagues  ADDIN REFMGR.CITE Payne200894Hemodynamic Performance of Stentless Versus Stented Valves: A Systematic Review and Meta-AnalysisJournal94Hemodynamic Performance of Stentless Versus Stented Valves: A Systematic Review and Meta-AnalysisPayne,Darrin M.Pavan,Koka H.Karanicolas,Paul J.Chu,Michael W.Dave,Nagpal A.Briel,MatthiasSch++nemann,Holger J.Lonn,Eva M.2008AdultAortic ValveHemodynamicsNot in File556564Journal of Cardiac Surgery2308860440Journal of Cardiac Surgery1(150). Superior hemodynamic performance has also previously been demonstrated previously for bioprostheses in complete supra-annular position compared to those placed intra-annullary  ADDIN REFMGR.CITE Botzenhardt20052Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic AnnulusJournal2Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic AnnulusBotzenhardt,FlorianEichinger,Walter B.Bleiziffer,SabineGuenzinger,RalfWagner,Ina M.Bauernschmitt,RobertLange,Ruediger2005Not in File20542060Journal of the American College of Cardiology45http://www.sciencedirect.com/science/article/B6T18-4G7X9MR-9/2/3bdbcc4575188faaddc74368b94bcbf3H:\Dokument\PEK II\ArtiklarJournal of the American College of Cardiology1(151), although these differences were not significant in patients with an aortic annulus of 18 to 20 mm in diameter. 1.12 The small aortic root and alternative surgical strategies Aortic valve replacement in patients with a small aortic annulus is often challenging for the surgeon in terms of prosthesis selection. Patients with a small annular size may be small individuals, and the small valve size will then be matched to their cardiac output needs. On the other hand, the use of small-sized prostheses in a larger patient may be the cause of PPM. One should also keep in mind that the measured internal or external diameter of a 19-mm valve may vary by up to 4 mm depending on the valve manufacturer  ADDIN REFMGR.CITE Christakis199846Inaccurate and misleading valve sizing: a proposed standard for valve size nomenclatureJournal46Inaccurate and misleading valve sizing: a proposed standard for valve size nomenclatureChristakis,G.T.Buth,K.J.Goldman,B.S.Fremes,S.E.Rao,V.Cohen,G.Borger,M.A.Weisel,R.D.1998Aortic ValveAortic Valve InsufficiencyAortic Valve StenosisBioprosthesisHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamicsHumansmethodsProsthesis DesignProsthesis FittingstandardssurgeryTerminology as TopicNot in File11981203Ann.Thorac Surg66
Division of Cardiovascular Surgery, Sunnybrook Health Science Centre and the Toronto Hospital, University of Toronto, Ontario, Canada
PM:9800806Ann.Thorac Surg1(152). No randomized studies have been performed to investigate whether a patient with a small aortic annulus is better treated by insertion of a 19-mm prosthetic valve or by root enlargement and the insertion of a larger valve. There are, however, several retrospective studies reporting conflicting results. Milano et al.  ADDIN REFMGR.CITE Milano20022Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-upJournal2Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-upMilano,A.D.De,Carlo M.Mecozzi,G.D'Alfonso,A.Scioti,G.Nardi,C.Bortolotti,U.2002adverse effectsAgedAortic ValveAortic Valve StenosisBody Surface AreaComparative StudyEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedmortalityMultivariate AnalysisProportional Hazards ModelsProsthesis DesignsurgeryTreatment OutcomeultrasonographyNot in File3743Ann.Thorac.Surg.73
Divisions of Cardiac Surgery and Cardiology, Cardio-Thoracic Department University of Pisa Medical School, Italy
PM:11834061Ann.Thorac.Surg.1(14) analyzed two groups of patients receiving 19 or 21 mm mechanical prostheses. According to their study, EOAi was not an independent predictor of early or late mortality, but a predictor of cardiac events for patients receiving 19 mm valves. The authors also reported incomplete regression of LVH in both groups of patients. Medalion et al.  ADDIN REFMGR.CITE Medalion2000310Aortic valve replacement: is valve size important?Journal310Aortic valve replacement: is valve size important?Medalion,B.Blackstone,E.H.Lytle,B.W.White,J.Arnold,J.H.Cosgrove,D.M.2000AdolescentAdultAgedAortic ValveAortic Valve StenosisBiocompatible MaterialsBioprosthesisComparative StudyepidemiologyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedmortalityProsthesis DesignReproducibility of ResultsRetrospective StudiesRisk FactorsstandardssurgerySurvival RatetransplantationTransplantation,HomologousTreatment OutcomeNot in File963974J.Thorac.Cardiovasc.Surg.119
Department of Thoracic and Cardiovascular Surgery and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
PM:10788817J.Thorac.Cardiovasc.Surg.1(58) investigated the relation of prosthesis size to survival after AVR. The statistical analyses in the study included multivariable propensity scores to adjust for valve selection factors, multivariable hazard function analyses to identify risk factors for all-cause mortality, and bootstrap resampling to quantify the reliability of the results. The risk of death was highest immediately after valve replacement but fell rapidly to its lowest level and gradually rose after about three months. No valve type or expression of valve size was identified as a risk factor. Adams et al.  ADDIN REFMGR.CITE Adams1999345Impact of small prosthetic valve size on operative mortality in elderly patients after aortic valve replacement for aortic stenosis: Does gender matter?Journal345Impact of small prosthetic valve size on operative mortality in elderly patients after aortic valve replacement for aortic stenosis: Does gender matter?Adams,D.H.Chen,R.H.Kadner,A.Aranki,S.F.Allred,E.N.Cohn,L.H.1999Aortic stenosisAortic ValveAortic valve replacementMalemethodsmortalityOdds RatioNot in File815822Journal of thoracic and cardiovascular surgery11800225223Journal of thoracic and cardiovascular surgery1(153) evaluated 366 patients over 70 years of age undergoing AVR using propensity scoring and multivariate analysis After combining male sex and small prosthesis size, the authors could demonstrate that the implantation of a standard 19-mm aortic valve in elderly men with aortic stenosis may be associated with an increased risk of operative mortality. On the other hand, larger aortic bioprostheses have previously been found to be associated with a lower incidence of re-operation  ADDIN REFMGR.CITE Ruel2004102Late incidence and determinants of reoperation in patients with prosthetic heart valvesJournal102Late incidence and determinants of reoperation in patients with prosthetic heart valvesRuel,M.Kulik,A.Rubens,F.D.Bedard,P.Masters,R.G.Pipe,A.L.Mesana,T.G.2004Adultadverse effectsAge FactorsAgedAortic ValveBioprosthesisBody Surface AreaCohort StudiescomplicationsCoronary ArteriosclerosisFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHeart ValvesHumansHypertrophy,Left VentricularMaleMiddle AgedMitral ValveProspective StudiesProsthesis DesignProsthesis FailureReoperationRisk FactorsSex FactorsSmokingsurgeryNot in File364370Eur.J.Cardiothorac.Surg.25
Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin Street, Suite 3403, Ottawa, Ont., Canada K1Y 4W7. mruel@ottawaheart.ca
PM:15019662Eur.J.Cardiothorac.Surg.1(154). This may be due to patients with larger prostheses tolerating stenosis or regurgitation secondary to SVD better, or it may reflect a true beneficial effect of larger prosthesis size on SVD, resulting from lower flow velocities and lower transprosthetic gradients. In cases of anticipated PPM, alternative procedures such as aortic root enlargement to accommodate a larger prosthesis of the same mode have been suggested  ADDIN REFMGR.CITE Pibarot200966Prosthetic heart valves: selection of the optimal prosthesis and long-term managementJournal66Prosthetic heart valves: selection of the optimal prosthesis and long-term managementPibarot,P.Dumesnil,J.G.2009Not in File10341048Circulation119
Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V-4G5. philippe.pibarot@med.ulaval.ca or medjgd@hermes.ulaval.ca
PM:19237674Circulation1(38). Previous studies have reported that this procedure can be performed safely for this purpose  ADDIN REFMGR.CITE Castro200228Routine enlargement of the small aortic root: a preventive strategy to minimize mismatchJournal28Routine enlargement of the small aortic root: a preventive strategy to minimize mismatchCastro,L.J.Arcidi,J.M.,Jr.Fisher,A.L.Gaudiani,V.A.2002AdultAgedAged,80 and overAortic ValveBody Surface AreaCardiac Surgical ProceduresFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityProsthesis DesignRetrospective StudiessurgeryNot in File3136Ann.Thorac Surg74
Department of Cardiovascular Surgery, Sequoia Hospital, Redwood City, California, USA
PM:12118799Ann.Thorac Surg1Dhareshwar2007361Aortic root enlargement: What are the operative risks?Journal361Aortic root enlargement: What are the operative risks?Dhareshwar,JayeshSundt III,Thoralf M.Dearani,Joseph A.Schaff,Hartzell V.Cook,David J.Orszulak,Thomas A.2007Aortic ValveAortic valve replacementFemaleLeft ventricular mass regressionmortalityOdds RatioReoperationRisk FactorsNot in File916924The Journal of Thoracic and Cardiovascular Surgery134http://www.sciencedirect.com/science/article/B6WMF-4PJ0C8V-1/2/3098728c44180d8c241d5b16f1adee5dThe Journal of Thoracic and Cardiovascular Surgery1(155;156), although the long-term clinical outcome is not improved  ADDIN REFMGR.CITE Kulik2008104Enlargement of the Small Aortic Root During Aortic Valve Replacement: Is There a Benefit?Journal104Enlargement of the Small Aortic Root During Aortic Valve Replacement: Is There a Benefit?Kulik,A.Al-Saigh,M.Chan,V.Masters,R.G.Bedard,P.Lam,B.K.Rubens,F.D.Hendry,P.J.Mesana,T.G.Ruel,M.2008Aortic ValveHeartHeart FailureIncidencemethodsmortalityRisksurgeryNot in File94100Ann Thorac Surg8500034975The Annals of Thoracic SurgeryAnn Thorac Surg1(157). Earlier studies showed that aortic annulus enlargement increased the operative mortality, but patients who underwent enlargement of a small aortic annulus had comparable long- term survival and freedom from cardiac- and valve-related death to those patients who received larger aortic prostheses  ADDIN REFMGR.CITE Sommers1997337Aortic valve replacement with patch enlargement of the aortic annulusJournal337Aortic valve replacement with patch enlargement of the aortic annulusSommers,K.E.David,T.E.1997AgedAnimalsAortic ValveAortic valve replacementBioprosthesisCase-Control StudiesCattleChi-Square DistributionEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHumansMalemethodsMiddle AgedmortalityPericardiumProportional Hazards ModelsRetrospective StudiessurgerySurvival RatetransplantationTransplantation,HeterologousultrasonographyNot in File16081612Ann Thorac Surg63
Division of Cardiovascular Surgery, The Toronto Hospital and the University of Toronto, Ontario, Canada
PM:9205157The Annals of Thoracic SurgeryAnn Thorac Surg1(44). In a recent study by Sakamoto et al.  ADDIN REFMGR.CITE Sakamoto2006336Prevalence and avoidance of patient-prosthesis mismatch in aortic valve replacement in small adultsJournal336Prevalence and avoidance of patient-prosthesis mismatch in aortic valve replacement in small adultsSakamoto,Y.Hashimoto,K.Okuyama,H.Takakura,H.Ishii,S.Taguchi,S.Kagawa,H.2006AdolescentAdultAgedAged,80 and overAortic ValveAortic valve replacementBody SizeBody Surface AreaFemaleHeart Valve ProsthesisHumansMalemethodsMiddle AgedPrevalenceProsthesis DesignReference ValuesRetrospective Studiesstandardsstatistics & numerical datasurgerySurvival RateTime FactorsNot in File13051309Ann Thorac Surg81
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan
PM:16564262The Annals of Thoracic SurgeryAnn Thorac Surg1(158) the incidence of PPM in small-built patients with small aortic roots in a Japanese population with or without annular enlargement was investigated. Their findings indicated that few patients developed PPM, especially those aged over 65 with a relatively small BSA, who were able to receive bioprosthetic valves. In patients with a small aortic annulus younger than 65, the method of first choice for avoidance of PPM was aortic annular enlargement, or the use of a high-performance bileaflet mechanical prosthesis as an alternative, with good results. Based on the current evidence, Pibarot et al.  ADDIN REFMGR.CITE Pibarot200966Prosthetic heart valves: selection of the optimal prosthesis and long-term managementJournal66Prosthetic heart valves: selection of the optimal prosthesis and long-term managementPibarot,P.Dumesnil,J.G.2009Not in File10341048Circulation119
Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V-4G5. philippe.pibarot@med.ulaval.ca or medjgd@hermes.ulaval.ca
PM:19237674Circulation1(38) suggested that aortic root enlargement should be considered only in patients in whom the risk of severe PPM cannot be avoided with the use of a better-performing prosthesis, and in whom the risk-to-benefit ratio of performing such a procedure is considered advantageous. Aims of this Research The general aim of the work presented in this thesis was to bring research on the concept of prosthesis-patient mismatch a step further in order to achieve a higher quality of treatment and to improve the outcome for patients undergoing aortic valve replacement. The specific aims were: To evaluate the impact of prosthesis-patient mismatch on in-hospital complications, and early and late mortality, following aortic valve replacement. (Paper I) To determine the impact of postoperative heart failure on early mortality following aortic vavle replacement and to determine whether B-type natriuretic peptide is predictive of postoperative heart failure. (Paper II) To investigate the influence of prosthesis-patient mismatch when using bioprostheses with respect to recovery of left ventricular diastolic function and left ventricular mass regression, and to evaluate the impact of prosthesis-patient mismatch on midterm outcome following the implantation of bioprostheses. (Paper III) To study the influence of prosthesis-patient mismatch on left ventricular remodeling and the recovery of left ventricular ejection fraction following aortic valve replacement for severe aortic valve insufficiency, and to evaluate the impact of prosthesis-patient mismatch on long-term survival. (Paper IV) Material and Methods 3.1 Patients Patients recruited for the four studies all underwent aortic valve replacement at the Department of Cardiothoracic Surgery, Lund University Hospital, Sweden. Risk factors for all adult patients were prospectively collected when the patient was admitted to the department. The data base contained a total of 248 variables (pre-, intra- and postoperative) based on the Higgins  ADDIN REFMGR.CITE Higgins199238Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity scoreJournal38Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients. A clinical severity scoreHiggins,T.L.Estafanous,F.G.Loop,F.D.Beck,G.J.Blum,J.M.Paranandi,L.1992AdultAgedCoronary Artery BypassFemaleHospitalsHumansLogistic ModelsMalemethodsMitral ValveMitral Valve InsufficiencyMorbiditymortalityMyocardial InfarctionOutcome Assessment (Health Care)Regression AnalysisReoperationRetrospective StudiesRisk FactorsSeverity of Illness IndexsurgeryTreatment OutcomeUnited StatesNot in File23442348JAMA267
Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, OH
PM:1564774JAMA1(159), Parsonnet  ADDIN REFMGR.CITE Parsonnet198937A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart diseaseJournal37A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart diseaseParsonnet,V.Dean,D.Bernstein,A.D.1989AdultCardiac Surgical ProceduresClassificationHeart DiseasesHospitalsHumansModels,TheoreticalmortalityOutcome and Process Assessment (Health Care)ProbabilityProspective StudiesRegression AnalysisRisk FactorsStatistics as TopicsurgeryNot in FileI312Circulation79
Department of Surgery, Newark Beth Israel Medical Center, New Jersey 07112
PM:2720942Circulation1(160), and STS  ADDIN REFMGR.CITE Edwards199413Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experienceJournal13Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experienceEdwards,F.H.Clark,R.E.Schwartz,M.1994AdultAgedAged,80 and overAnalysis of VarianceBayes TheoremCause of DeathCoronary Artery BypassDatabases,FactualFemaleHumansMalemethodsMiddle AgedModels,BiologicalmortalityProbabilityRisk AssessmentRisk FactorsSocieties,Medicalstandardsstatistics & numerical datasurgeryThoracic SurgerytrendsNot in File1219Ann.Thorac Surg57
Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville 32209-6511
PM:8279877Ann.Thorac Surg1(161) patient record forms. Survival data and cause of death were obtained from the Swedish National Board of Health and Welfare (Socialstyrelsen) or, if necessary, from patient records. The study described in Paper I was conducted on a series of 2016 consecutive patients undergoing a total of 2031 AVR procedures between January 1996 and July 2006. Paper II describes a study in which 161 patients undergoing AVR between September 2006 and October 2007 were included. The selection was based on consecutive AVR procedures during a period of time when all cardiac surgery patients were routinely screened in the ICU for BNP using a point-of-care device (Triage, Biosite Diagnostics, San Diego, CA, USA). Paper III presents a study of 372 patients undergoing AVR with the Sorin Soprano bovine pericardial bioprosthesis (Sorin Biomedica Cardio SpA, Saluggia, Italy; n=235) and the Medtronic Mosaic porcine bioprosthesis (Medtronic Inc, MN, USA; n=137) between July 2004 and February 2007. The study described in Paper IV included a series of 230 consecutive patients undergoing AVR between January 1998 and October 2008 based on the inclusion criterion of severe aortic insufficiency. 3.2 Study design 3.2.1 Paper I The EOAi was calculated in 1797/2016 patients. Data were missing for the other patients. Patients with moderate or severe PPM were compared to patients without PPM to evaluate the impact of PPM on postoperative complications. Stepwise logistic regression was performed to determine whether PPM was an independent predictor of the different outcomes. If any of the outcomes were independently predicted by PPM, separate uni- and multivariate analyses were performed for that specific outcome to assess its multivariate risk factors, adjusting for any confounding factors. Furthermore, the influence of PPM on 30-day mortality and long-term survival was addressed. 3.2.2 Paper II B-type natriuretic peptide was measured in 161 patients undergoing AVR with or without CABG. We sought to validate BNP as a biomarker for postoperative heart failure following AVR in order to facilitate the diagnosis of low cardiac output syndrome (LCOS) in this patient category. Receiver operating characteristic (ROC) analysis was performed to assess the discriminatory ability of BNP to predict LCOS, 30-day mortality and several other postoperative complications The incidence of LCOS was evaluated, as was the relationship between PPM and BNP. 3.2.3 Paper III In this paper, two novel approaches were employed to evaluate PPM. The first was to assess the influence of PPM with respect to the recovery of LV diastolic function. It was postulated that if PPM caused an increased afterload on the LV, thereby inhibiting LVMR following AVR, than any preexisting LV diastolic dysfunction would increase as LVH is a known cause of DHF. Second, despite progress in the design and construction of bioprostheses, their hemodynamic performance is not yet comparable to that of the native aortic valve. Third-generation bioprostheses designed for complete supra-annular implantation offer an alternative for improved hemodynamics, as the stent is positioned so as to cause less disturbance of aortic blood flow  ADDIN REFMGR.CITE Pavoni20061Results of Aortic Valve Replacement With a New Supra-Annular Pericardial Stented BioprosthesisJournal1Results of Aortic Valve Replacement With a New Supra-Annular Pericardial Stented BioprosthesisPavoni,DaisyBadano,Luigi P.Musumeci,Sergio F.Frassani,RomeoGianfagna,PasqualeMazzaro,EnzoLivi,Ugolino2006Not in File21332138The Annals of Thoracic Surgery82http://www.sciencedirect.com/science/article/B6T11-4MD7RR2-18/2/1d42a475668ebd12dc894f43e415dcaeH:\Dokument\PEK II\ArtiklarThe Annals of Thoracic Surgery1(162), potentially leading to a decrease in the incidence of PPM and having less impact on clinical outcome. The Sorin Soprano bovine pericardial bioprosthesis (Sorin Biomedica Cardio SpA, Saluggia, Italy) is a third-generation bioprosthesis designed for complete supra-annular implantation, and was chosen for evaluation and comparison with the performance of the more established Medtronic Mosaic porcine bioprosthesis (Medtronic Inc, MN, USA). 3.2.4 Paper IV As previously demonstrated by Rahimtoola  ADDIN REFMGR.CITE Rahimtoola1978306The problem of valve prosthesis-patient mismatchJournal306The problem of valve prosthesis-patient mismatchRahimtoola,S.H.1978adverse effectsanatomy & histologyConstriction,PathologicetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart ValvesHemodynamic ProcessesHumanspathologyphysiopathologyNot in File2024Circulation58PM:348341Circulation1(1), for some patients (i.e., those with severe aortic insufficiency), abnormality in one valve leads to abnormality in another following surgery, with mild to moderate LV outflow obstruction as a result of PPM. However, previous studies have demonstrated that PPM is most likely to occur in patients in whom the predominant lesion is aortic stenosis, as the calcified aortic valve and aortic root present a surgical challenge for the implantation of a prosthetic valve with an adequate EOA  ADDIN REFMGR.CITE Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1(9). Because aortic insufficiency often presents with annular dilatation and an absence of valve calcification, this condition would intuitively be thought to be unrelated to PPM. Nevertheless, aortic insufficiency has been included in the analyses of earlier reports investigating the clinical relevance of PPM. Based on the findings of Rahimtoola  ADDIN REFMGR.CITE Rahimtoola1978306The problem of valve prosthesis-patient mismatchJournal306The problem of valve prosthesis-patient mismatchRahimtoola,S.H.1978adverse effectsanatomy & histologyConstriction,PathologicetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart ValvesHemodynamic ProcessesHumanspathologyphysiopathologyNot in File2024Circulation58PM:348341Circulation1(1) it was postulated that if PPM were present following AVR for severe aortic insufficiency, the residual gradients and increased afterload may influence LV remodeling. As such, these patients constitute an in vivo model to evaluate PPM and its impact on LV volumes, mass, and systolic performance. Patients with acute endocarditis (defined as ongoing antibiotic treatment at the time of surgery) were included in the study for the purpose of overall survival analysis. However, these patients were excluded when evaluating postoperative LV remodeling since the pathophysiology of chronic aortic insufficiency with respect to LV dimensions differs from that of acute aortic insufficiency caused by endocarditis. 3.3 Anesthetic management Standard premedication with a benzodiazepine was used for all patients. Beta-blocking agents were given until the day of surgery. Standardized anesthesia was used in all patients, including induction by propofol infusion, fentanyl, and succinylcholine and maintenance of anesthesia by continuous infusion of propofol, intermittent doses of fentanyl, and vecuronium bromide. Propofol was then administered continuously during cardiopulmonary bypass (CPB), until the end of surgery, and for the first hours in the intensive care unit. Standard monitoring techniques (5-lead electrocardiogram, central venous pressure, and invasive arterial blood pressure) were used in all patients and complied with routine practice at the department. 3.4 Surgical management After median sternotomy, all patients underwent AVR with CPB performed under mild hypothermia (34C). Myocardial protection was achieved by intermittent anterograde or combined (anterograde plus retrograde) cold blood cardioplegia. The prostheses were implanted and oriented in accordance with the manufacturers recommendations. With regard to sizing of the prosthesis, the surgeon determined the largest size hosted by the annulus using the specific sizers provided by the manufacturer. The final choice of the prosthesis size was based on the sizing of the patients annulus and the best fitting sizer at time of surgery and complied with routine practice at the department. Prostheses were implanted by means of multiple interrupted sutures reinforced with Teflon pledgets placed below the aortic annulus. Postoperative care was provided in the ICU by anesthesiologists and by cardiothoracic surgeons in the ward. 3.5 Triage BNP test Whole blood samples (5 mL) were collected in tubes containing potassium EDTA, and the BNP level was analyzed immediately using a point-of-care device (Triage, Biosite Diagnostics, San Diego, CA), as described in Paper II. The samples were obtained immediately on admittance to the ICU (D0) and on the first postoperative day (D1). This postoperative time point was chosen in accordance with previous reports showing that the maximum BNP value remains unchanged up to 6 hours after cardiac surgery  ADDIN REFMGR.CITE Morimoto1998118Perioperative changes in plasma brain natriuretic peptide concentrations in patients undergoing cardiac surgeryJournal118Perioperative changes in plasma brain natriuretic peptide concentrations in patients undergoing cardiac surgeryMorimoto,K.Mori,T.Ishiguro,S.Matsuda,N.Hara,Y.Kuroda,H.1998AdultbloodCardiac Surgical ProceduresCardiopulmonary BypassFemaleHeart FailureHemodynamicsHumansIntraoperative PeriodMaleMiddle AgedNatriuretic Peptide,BrainNerve Tissue ProteinsphysiologyPostoperative PeriodProspective StudiesStroke VolumesurgeryTime FactorsVentricular functionVentricular Function,LeftNot in File2329Surg Today28
Second Department of Surgery, Tottori University Faculty of Medicine, Japan
PM:9505313Surg Today1(163), and that a single 24-hour BNP value is a significant predictor of cardiac dysfunction  ADDIN REFMGR.CITE Provenchere20063Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortalityJournal3Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortalityProvenchere,S.Berroeta,C.Reynaud,C.Baron,G.Poirier,I.Desmonts,J.M.Iung,B.Dehoux,M.Philip,I.Benessiano,J.2006adverse effectsAgedanalysisbloodCardiac Surgical ProceduresCardiopulmonary BypassetiologyFemaleHeart DiseasesHumansMaleMiddle AgedmortalityMultivariate AnalysisNatriuretic Peptide,BrainPrognosisProspective StudiesRisk AssessmentsurgeryTime FactorsTroponinTroponin INot in File9951000Crit Care Med.34
Departement d'Anesthesie-Reanimation-Chirurgicale, Groupe Hospitalier Bichat-Claude Bernard (AP-HP), Faculte Xavier Bichat (Universite Paris 7), France
PM:16484891H:\Dokument\PEK III\ArtiklarCrit Care Med.1(113) and is associated with short- and long-term adverse outcomes in cardiac surgical patients  ADDIN REFMGR.CITE Hutfless200498Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryJournal98Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryHutfless,R.Kazanegra,R.Madani,M.Bhalla,M.A.Tulua-Tata,A.Chen,A.Clopton,P.James,C.Chiu,A.Maisel,A.S.2004AgedbloodCardiac Surgical ProcedurescomplicationsHeart DiseasesHumansLength of StayMaleMiddle AgedmortalityNatriuretic Peptide,BrainPerioperative CarePostoperative ComplicationsPredictive Value of TestsRisk AssessmentsurgeryTreatment OutcomeNot in File18731879J.Am.Coll.Cardiol.43
University of California, San Diego, San Diego, California, USA
PM:15145114http://www.sciencedirect.com.ludwig.lub.lu.se/science?_ob=MImg&_imagekey=B6T18-4CCF2G1-W-9&_cdi=4884&_user=745831&_orig=search&_coverDate=05%2F19%2F2004&_sk=999569989&view=c&wchp=dGLbVlb-zSkWW&_valck=1&md5=21a385ff42398bbbc722df9cfdb1bae4&ie=/sdarticle.pdfJ.Am.Coll.Cardiol.1(112). Samples were obtained daily from patients showing increasing BNP levels until the peak concentration of BNP was reached (Dmax). No further samples were taken from patients showing a decline in BNP level on the first postoperative day (D1Evangelista20083European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studiesJournal3European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studiesEvangelista,ArturoFlachskampf,FrankLancellotti,PatrizioBadano,LuigiAguilar,RioMonaghan,MarkZamorano,JoseNihoyannopoulos,Petroson behalf of the European Association of Echocardiography,2008Not in File438448Eur J Echocardiogr9http://ejechocard.oxfordjournals.org/cgi/content/abstract/9/4/438European Journal of EchocardiographyEur J Echocardiogr1(164) and averaged over three cycles in sinus rhythm and six cycles in the presence of atrial fibrillation. Long- and short-axis views were obtained from the parasternal window, and LV inner dimensions were measured at end-diastole, and at end-systole using M-mode echocardiography. The left ventricular end-diastolic diameter (LVEDD) was defined as the beginning of the Q-wave on the electrocardiogram (ECG). The left ventricular end-systolic diameter (LVESD) was measured as the smallest LV dimension during the period between peak septal motion and peak anterior movement of the LV posterior wall. If possible, the LV mass was calculated using the formula LV mass = 1.04 [(LVIDd + IVSd + LPWDd) 3 - (LVIDd) 3] - 13.6, and was normalized to the patients BSA. In cases where the acoustic window was poor, wall thickness was assessed visually, and LVH categorized as normal, mild, moderate, or severe. Regional and global LV systolic function was assessed from the apical two- and four-chamber view. LV systolic function was defined as impaired if there was evidence of global or regional hypokinesia in more than one segment of the left ventricle. The LVEF was determined using the area-length method described in Paper III and, if applicable, calculated using the modified Simpsons method, as described in Paper IV. The pressure gradients (peak and mean) of the prostheses were calculated from continuous-wave Doppler measurements using the modified Bernoulli equation. Regurgitant jets were localized, and then graded using a combination of the diameter of the base of the jet, the extension of the jet into the left ventricle, and the density and slope of the aortic regurgitant signal recorded during continuous-wave Doppler measurements. The EOA of the prosthesis was estimated by multiplying the time-velocity integral ratio between LV outflow tract and the prosthesis by the area of the LV outflow tract, using the continuity equation. In the study presented in Paper III, the diastolic function was determined and defined accordingly: LV inflow was measured in pulsed-wave Doppler mode at the tip of the mitral valve leaflets, and the following variables were recorded: peak velocity of early (E) and late (A) filling, and the deceleration time of the E wave velocity. Diastolic function was graded as normal, impaired relaxation, pseudonormal, or restrictive filling. Normal was defined as an E wave velocity greater than the A wave velocity and normal-sized left atrium. Impaired relaxation was defined as E wave velocity lower than A wave velocity and deceleration time greater than 250 ms. Pseudonormalization was defined as E wave velocity higher than A wave velocity, enlarged left atrium, and an E/A ratio greater than 1. The E wave was correlated to the e2 from the tissue Doppler velocity of the medial atrioventricular plane and the ratio was calculated. In patients with E greater than A, an E/e2 = ratio greater than 15 was considered pathologic, indicating that the patient had a moderate diastolic dysfunction with a pseudonormal inflow of the LV. Restrictive filling was defined as an E/A ratio greater than 2 and deceleration time less than 150 ms. 3.7 Definitions In the first study (Paper I), the indexed EOA for each prosthesis was derived from previously published reference values of EOA divided by the patients body surface area. The application of this method is referred to as the projected EOAi and has previously been described and validated by Pibarot et al.  ADDIN REFMGR.CITE Pibarot200613Prosthesis-patient mismatch: definition, clinical impact, and preventionJournal13Prosthesis-patient mismatch: definition, clinical impact, and preventionPibarot,P.Dumesnil,J.G.2006Aortic ValveBlood Loss,SurgicalBody SizeetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansmortalityPostoperative ComplicationsProsthesis DesignProsthesis FittingResearch Support,Non-U.S.Gov'tRisk FactorssurgeryTreatment OutcomeVentricular Dysfunction,LeftNot in File10221029Heart92
Research Group in Valvular Heart Disease, Laval Hospital Research Centre/Quebec Heart Institute, Laval University, Sainte-Foy, Quebec, Canada. philippe.pibarot@med.ulaval.ca
PM:16251232Heart1Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1(9;10). In the second study (Paper II), patients were defined as suffering from postoperative heart failure (i.e., LCOS) if inotropic support was required for >24 hours (dobutamine or levosimendan with or without additional norepinephrine infusion) or if treatment with an intra-aortic balloon pump (IABP) was required for more than 24 hours in the ICU. The institution of inotropic support was left to the discretion of the individual physician, and was guided by hemodynamic data (mean arterial pressure <60 mmHg, SvO2 <55%, CVP >15 cmH2O, lactate >3 mmol/L, oliguria, and if a pulmonary artery catheter was present: cardiac index <2.2 L/min/m2, pulmonary artery pressure >30 mmHg, systemic vascular resistance <800-1000 dynes s cm5) and echocardiographic evidence of LV or right ventricular dysfunction. The use of an IABP was indicated by deteriorating circulation and increasing filling pressure after weaning from CPB. In the third study (Paper III), the EOA was determined using echocardiographic (in vivo) measurements. There are several pitfalls associated with in vivo EOA measurements inherent to the method of echocardiography. However, this method has been described and validated by Mohty-Echahidi et al. ADDIN REFMGR.CITE Mohty-Echahidi2006334Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic positionJournal334Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic positionMohty-Echahidi,D.Malouf,J.F.Girard,S.E.Schaff,H.V.Grill,D.E.Enriquez-Sarano,M.E.Miller,F.A.,Jr.2006AgedAortic ValveAortic Valve InsufficiencyAortic valve replacementBody Surface AreaEchocardiographyFemaleHeart Failure,CongestiveHeart Valve ProsthesisHumansIncidenceMalemethodsMiddle AgedmortalityMultivariate AnalysisPostoperative ComplicationsPredictive Value of TestsProportional Hazards ModelsRisk Factorsstatistics & numerical dataStroke VolumesurgerySurvival RateultrasonographyNot in File420426Circulation113
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
PM:16415379Circulation1(56) and we hypothesized that the in vivo measurement might reflect a more clinically relevant scenario than in vitro measurements of EOA. In the final study (Paper IV), the projected EOAi was applied for the determination of PPM. Due to insufficient published data for the St Jude Epic Supra (size 27) and Mitroflow Pericardial (size 27) bioprostheses, echocardiographic measurements were used to derive the EOA for two patients. In all studies, the PPM was defined as not clinically significant if the EOAi was >0.85 cm2/m2, as moderate if it was between d"0.85 cm2/m2 and 0.65 cm2/m2, and as severe if it was d"0.65 cm2/m2. Early mortality was defined as all-cause mortality within 30 days of surgery. 3.8 Statistical analyses All statistical analyses were performed and graphs plotted using the SPSS statistical software package (SPSS 15.0, Chicago, IL, USA), except in the first study (Paper I), where the Intercooled Stata statistical package version 9.2 (Stata Corporation, College Station, TX, USA) was employed. Statistical significance was defined as pd"0.05. Results were provided in standard fashion, with categorical data as proportions, and continuous variables expressed as mean SD. Students t-test was used to evaluate continuous variables. For categorical variables, the chi-squared test was used, except when the expected frequencies were lower than five, in which case Fishers exact test was used. For continous variables not following a normal distribution, a non-parametric analysis (Mann-Whitney U test) was used. Multivariate analyses were performed in all studies using stepwise logistic regression analysis to determine independent predictors for the different outcomes (in-hospital complications and 30-day mortality). The inclusion criterion for the full model for each outcome was p<0.2, and the limit for stepwise backward and forward elimination was p<0.1. In Paper I, patients for whom any risk factor used in the model was missing were excluded from the analysis. In Papers II-IV missing values were replaced using the probability imputation technique  ADDIN REFMGR.CITE Schemper199070Efficient evaluation of treatment effects in the presence of missing covariate valuesJournal70Efficient evaluation of treatment effects in the presence of missing covariate valuesSchemper,M.Smith,T.L.1990Antineoplastic Combined Chemotherapy ProtocolsBreast NeoplasmsClinical TrialsCombined Modality TherapyFemaleHumansmethodsMonte Carlo MethodProbabilityStatisticstherapeutic usetherapyNot in File777784Stat.Med9
Department of Biomathematics, University of Texas M.D. Anderson Cancer Center, Houston 77030
PM:2218180Stat.Med1(165). Receiver operating characteristic analysis and the Hosmer-Lemeshow goodness-of-fit test were used in the first two studies (Paper I & II) to describe discriminatory performance and the predictive accuracy of the model. The Kaplan-Meier estimate of the survivor function was used in all studies to plot long-term survival for the groups compared. The log-rank test was used to compare statistical differences between the groups. The stepwise Cox proportional hazards analysis model was used for risk adjustment to identify independent risk factors for overall mortality after AVR. In the second study (Paper II), the correlation coefficients were calculated using Pearsons linear model. The threshold for BNP was determined by the ROC coordinates for maximal sensitivity and minimal loss of specificity. The best cutoff point for clinical use was chosen based on the approach of minimizing errors equivalent to maximizing the sum of sensitivity and specificity. The discriminatory power (i.e., the c-index) was evaluated by calculating the areas under the ROC curves. To compare the areas under the resulting ROC curves, the nonparametric approach described by DeLong et al.  ADDIN REFMGR.CITE DeLong1988141Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approachJournal141Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approachDeLong,E.R.DeLong,D.M.Clarke-Pearson,D.L.1988AlgorithmsanalysisAnalysis of VariancecomplicationsFemaleHumansIntestinal ObstructionmethodsModels,StatisticalOvarian NeoplasmsPredictive Value of TestsRoc CurvesurgeryNot in File837845Biometrics44
Quintiles, Inc., Chapel Hill, North Carolina 27514
PM:3203132Biometrics1(166) was used. In the third study (Paper III), the Wilcoxon signed-rank test and the McNemar test were used to assess differences between two related continous variables. In the final study (Paper IV), the paired-sample t-test was used to compare changes in preoperative and postoperative echocardiographic data (intra-group comparison). 3.9 Ethical aspects The studies were performed according to the principles of the Helsinki Declaration of Human Rights and were approved by the Ethics Committee for Medical Research at the Medical Faculty of Lund University, Sweden. Written informed consent was obtained ftom the patients in study III. Results 4.1 Impact of patient-prosthesis mismatch on in-hospital complications According to univariate analysis, postoperative atrial fibrillation, postoperative neurological events and prolonged ICU stay were significantly more common in patients with PPM. However, following multivariate analysis only an increased risk of postoperative neurological events (OR 2.26, 95%CI 1.05-4.83, p=0.037) was independently associated with PPM (EOAi d"0.85 cm2/m2) (Table 3.1). Table 3.1.Results of univariate and multivariate analysis of in-hospital complications for patients with and without PPM after AVR PPM EOAid"0.85 (cm2/m2)Non-PPM EOAi>0.85 (cm2/m2)UnivariateMultivariaten%n%p-valuep-valueAF 33540.423731.0<0.001nsIABP 40.570.90.306LCOS354.3445.80.176nsAMI 253.1263.40.695Renal failurea496.0364.80.274MOF40.530.40.774Reoperation for bleeding505.2505.80.603Neurological eventb8110.0304.0<0.0010.002Hours on ventilatorc17.653.216.742.50.755LOS ICU (days)c2.03.11.72.20.018nsLOS total (days)c10.57.610.16.80.24130-day mortality222.3242.80.518 AF = atrial fibrillation; IABP = intra-aortic balloon pump; LCOS = low cardiac output syndrome; AMI = acute myocardial infarction; aSerum creatinine >200 mol/L; MOF = multi-organ failure; bincluding TIA/RIND/CVI; cmean SD; LOS = length of stay. 4.2 Risk factors for postoperative neurological events Due to the multifactorial nature of postoperative neurological complications, separate uni- and multivariate analyses were performed for risk factors for postoperative neurological events. The multivariate analysis highlighted several independent risk factors for postoperative neurological events, including PPM (Table 3.2). The discriminatory ability of the logistic model was assessed by ROC analysis with an AUC of 0.80 (95% CI 0.75-0.85). The p-value for the Hosmer-Lemeshow goodness-of-fit test was 0.84, indicating adequate calibration. Table 3.2 Multivariate risk factors for postoperative neurological events (CVI;RIND;TIA) Risk factorOR95% CIp-valuePPM (EOAi d" 0.85 cm2/m2)2.261.10-4.830.037BMI 1.101.03-1.170.004DM2.531.33-4.800.005CPB (min)1.031.01-1.04<0.001Age1.051.01-1.100.014Cross-clamping time0.970.95-0.990.006PPM = patient-prosthesis mismatch; BMI = body mass index; DM = diabetes mellitus; CPB = cardiopulmonary bypass 4.3 Left ventricular mass regression and diastolic dysfunction The reduction of both peak and mean transvalvular gradients after AVR resulted in a significant reduction of LV mass index, 144 43 g/m2 (preoperatively) versus 126 40 g/m2 (postoperatively; p<0.001; n = 127). There was no significant difference in LV mass regression between patients with moderate PPM (p = 0.535) or severe PPM (p = 0.653) and patients without PPM. The implantation of a Sorin Soprano or Medtronic Mosaic prosthesis was not a predictor of postoperative improvement of diastolic (p=0.714) or systolic LV function (p=0.276). Neither moderate (p=0.726) nor severe PPM (p=0.353) was a predictor of impaired diastolic or systolic LV function (p=0.519 and p=0.083, respectively) postoperatively. Patients with moderate PPM had significantly higher mean (16.5 5.5 mm Hg versus 14.0 5.8 mm Hg; p=0.004) and peak (29.9 9.6 mm Hg versus 25.7 9.5 mm Hg; p=0.005) transprosthetic gradients than patients without PPM. Similarly, patients with severe PPM had significantly higher mean (17.7 5.3 mm Hg versus 14.9 5.6 mm Hg; p<0.001) and peak (32.8 9.3 mm Hg versus 26.6 9.3 mm Hg; p<0.001) transprosthetic gradients than patients with moderate PPM or without PPM. The hemodynamic performance of the prostheses presented in Paper III is summarized in Table 3.3. Table 3.3 Preoperative and postoperative Doppler echocardiographic parameters Sorin SopranoSize 18 (18.00 mm)20 (19.96 mm)22 (21.89 mm)24 (23.91 mm)(n=63)(n=92)(n=62)(n=18)Preop.Postop.Preop.Postop.Preop.Postop.Preop.Postop.Mean gradient (mmHg)5017196 (n=48)4416155 (n=71)4315145 (n=49)3413124 (n=14)Peak gradient (mmHg)82283310 (n=48)7625278 (n=70)7323258 (n=49)5817237 (n=14)EOA (cm2) 0.650.21.190.3 (n=45)0.70.21.30.2 (n=68)0.70.21.40.4 (n=47)0.70.21.70.6 (n=13)LVMI (g/m2)1343312344 (n=14)1354412740 (n=33)1453913338 (n=23)239614464! (n=7)EOAi (cm2/m2) -0.700.2 (n=45)-0.710.1 (n=68)-0.730.2 (n=47)-0.890.3 (n=13)PPM (%) EOAi (d" 0.85 cm2/m2) EOAi (d" 0.65 cm2/m2) - - 89 40 - - 88* 38* - - 81* 36* - - 62* 15*Medtronic MosaicSize 19 (16.58 mm)21 (18.51 mm)23 (20.56 mm)25&27 (22.55& 24.06 mm)(n=8)(n=47)(n=52)(n=28+2)PreopPostopPreopPostopPreopPostopPreopPostopMean gradient (mmHg)665218 (n=5)5419187 (n=34)4120166 (n=42)3911165 (n=21)Peak gradient (mmHg)84333912 (n=5)90283313 (n=34)75263010 (n=42)7017309 (n=21)EOA (cm2)0.50.11.30.4 (n=5)0.60.21.30.5 (n=31)0.70.21.30.3 (n=39)0.90.31.60.4 (n=21)LVMI (g/m2)NA14644 (n=2)1504711229 (n=17)1504011229 (n=20)1564714743 ! (n=11)EOAi (cm2/m2)-0.80.2 (n=5)-0.80.3 (n=31)-0.70.2 (n=39)-0.80.2 (n=21)PPM (%) EOAi (d" 0.85 cm2/m2) EOAi (d" 0.65 cm2/m2) - - 60 40 - - 68* 42*  - - 82* 59* - - 71* 29 (p=0.03)Values are means SD. p<0.05 preop. vs. postop.; p<0.05 between valve sizes postoperatively; * p=ns between valve sizes; EOA= effective orifice area; EOAi= indexed effective orifice area; LVMI= left ventricular mass index; NA = data not available 4.4 Left ventricular remodeling following AVR for severe aortic valve insufficiency The overall incidence of PPM (EOAi d"0.85 cm2/m2) was 22.2% (51/230). The incidence of severe PPM (EOAi d" 0.65 cm2/m2) was 2.2% (6/230). There was no significant difference in the reduction of mean LVEDD (p=0.31) or mean LVESD (p=0.79) between the non-PPM and the PPM groups. The LVEDD was reduced in the non-PPM group from 669 mm to 559 mm postoperatively (p<0.001) while the LVEDD in the PPM group was reduced from 659 mm to 5610 mm (p<0.001). The LVESD was reduced in the non-PPM group from 4910 mm to 4010 mm postoperatively (p<0.001) while the LVESD in the PPM group was reduced from 5011 mm to 3910 mm (p<0.001). Patients with preoperative LV dysfunction (ejection fraction <50%) demonstrated a significant improvement in postoperative LVEF in both the non-PPM (368% to 4412%, p<0.001) and PPM groups (337% to 4611%, p=0.001) but no significant difference could be demonstrated in the rate of improvement between the two groups (p=0.23). The influence of PPM on LV dimensions, LVEF and transprosthetic gradients during follow-up are summarized in Table 3.4. Table 3.4 Pre- and postoperative Doppler echocardiographic data for patients undergoing AVR for severe aortic valve insufficiency Non-PPMPPMp-value (95% CI)Preoperative variablesLVEDD (mm)6696590.49 (-2.4-5.0)LVESD (mm)491050110.63 (-7.0-4.2)LVEF (%)471045120.36 (-2.3-6.2)LVH moderate/severe (%)40 (36)5 (25) 0.35Postoperative variablesLVEDD (mm)55956100.67 (-5.3-3.4)LVEDD reduction (mm)119 (<0.001)910 (<0.001)0.31 (-2.1-6.8)LVESD (mm)401039110.64 (-4.0-6.5)LVESD, reduction (mm) 910 (<0.001)817 (<0.001)0.79 (-5.9-7.7)LVEF (%)481148110.94 (-5.0-5.4)LVEF, absolute improvement (%)111(0.169)213 (0.443)0.74 (-4.4-6.3)LVH moderate/severe (%)39 (42)2 (18)0.20LVM, (g) mean reduction 37117 (0.068)4859 (0.141)0.72Mean gradient (mmHg)1461750.14 (-6.9-0.9)Max gradient (mmHg)2493310<0.001 (4.0-13.1)Values given are mean SD, or percentage of patients. LVEDD = left ventricular end-diastolic diameter, LVESD = left ventricular end-systolic diameter; LVEF = left ventricular ejection fraction; LVH = left ventricular hypertrophy. Cases with endocarditis were not excluded from the evaluation of LVH. intra-group comparison; Wilcoxon signed ranks test 4.5 Predictors of postoperative heart failure Patients with postoperative heart failure (n=37) demonstrated a more than 10-fold increase in 30-day mortality (8.1%, 3/37) than patients without postoperative heart failure (0.8%, 1/124), p=0.038. Two levels of BNP were evaluated, the median (BNP >133 pg/mL) and a cutoff (BNP >82 pg/mL) based on ROC analysis (Figure 3.1). The inclusion of the cutoff level 82 pg/mL in multivariate analysis rendered the following independent predictors of PHF: BNP (D0) >82 pg/mL (OR 5.9, p=0.004; 95%CI, 1.7-20), chronic obstructive pulmonary disease (COPD) (OR 17.8; p<0.001; 95% CI, 3.9-80), operative fluid balance (mL) (OR 1.0004; p=0.002; 95% CI, 1.0001-1.001), and CPB time (min) (OR 1.02; p=0.005; 95% CI, 1.005-1.03). The independent predictors of PHF when the cutoff for BNP (D0) was 133 pg/mL in multivariate analysis are presented in Table 3.5. The area under the ROC curve for BNP as a predictor of postoperative heart failure was 0.69. The evaluated BNP levels were not found to be independent predictors of prolonged ICU stay (>48 hours) or prolonged ventilator support (>48 hours) in multivariate analysis.  Figure 3.1 ROC curve: BNP level on arrival at the ICU vs. postoperative heart failure. AUC = 0.69. Table 3.5. Independent predictors of postoperative heart failure following AVR VariableORp-value95%CIChronic obstructive pulmonary disease15.3<0.0013.7-64BNP >133 pg/mL3.40.0131.3-8.7Operative fluid balance (mL)1.00040.0021.0001-1.001Cardiopulmonary bypass time (min)1.0200.0021.007-1.033 4.6 Impact of PPM on early mortality In the first study (Paper I), the overall 30-day mortality was 2.6% (46/1797). Severe PPM was present in 3.8% of the study population (n=68), and moderate PPM in 49.5% (n=890). There were no significant differences in 30-day mortality between the severe, moderate and non-PPM groups. Causes of early mortality were cardiac-related in 67% of patients (30/45) and non-cardiac in 33% (15/45), and were distributed evenly between the PPM and non-PPM groups (p=ns). The same risk variables that were used to analyze risk factors for postoperative neurology in Paper I were also used in uni- and multivariate analyses to identify risk factors for 30-day mortality. Independent risk factors for 30-day mortality in multivariate analysis were: age >80 years (OR 3.0, p<0.001), preoperative NYHA class IV (OR 2.9, p=0.004), preoperative atrial fibrillation (OR 3.2, p=0.001) and cross-clamp time (min) (OR 1.02, p<0.001). The 30-day mortality was significantly higher in the second study in patients with heart failure (group II, 8.1%, 3/37) than in patients without postoperative heart failure (group I, 0.8%, 1/124; p=0.038) following AVR with or without concomitant CABG. The cause of death was cardiac-related in all patients (circulatory collapse, 4/4). There was no significant relation between the BNP levels and 30-day mortality (BNP>82 pg/mL, p=0.298 and BNP>133 pg/mL, p=1.0). ROC analysis of BNP (D0) and 30-day mortality produced a non-significant AUC (p=0.27). The overall 30-day mortality in the third study was 1.7% (4 of 235 patients) in the Sorin Soprano group and 2.9% (4 of 137 patients) in the Medtronic Mosaic group (p=0.473). None of the early deaths occurred during the operation. Causes of 30-day mortality were cardiac-related in 3 of 8 patients and noncardiac in 5 of 8 of the patients (gastrointestinal hemorrhage in 1 patient, cerebrovascular insult in 2 patients, ischemic bowel disease in 1 patient, renal failure in 1 patient). Multivariate analysis identified advanced age (p=0.030), preoperative myocardial infarction (p=0.049), diabetes mellitus (p=0.026), female sex (p=0.025), moderate aortic annular calcification (p=0.042), perioperative myocardial infarction (p=0.036), and postoperative cerebrovascular insult (p=0.031) as independent risk factors for 30-day mortality. Early mortality was not affected by moderate (p=1.000) or severe PPM (p=0.565). No significant differences were found when comparing the two valve groups regarding postoperative complications (re-operation for bleeding, p=0.662; postoperative atrial fibrillation, p=0.465; LCOS, p=0.239; renal failure, p=0.121; and length of stay in the ICU, p=0.270). In the final study, the 30-day mortality rate was 2.2% (5/230). Two of the early deaths were mors in tabula. The causes of 30-day mortality were cardiac failure in four patients and renal failure in one patient. Early mortality was not affected by moderate (p = 0.31) or severe PPM (p = 1.0). Postoperative renal dysfunction (serum creatinine >200 mmol/L) occurred in 14% (7/50) of the patients with PPM and in 4% (6/178) of the patients without PPM (p = 0.01). Three of these patients required hemodialysis postoperatively. There was a significant association between PPM and a prolonged need for inotropic support (>24 h) (n=10 (20%) vs. n=17 (10%), p=0.043). 4.7 Impact of PPM on late mortality The log-rank test showed a significant difference in long-term survival for patients with PPM compared to those without, p=0.006 (Paper I) (Figure 3.2). However, following adjustment for potential confounders in multivariate analysis, PPM was not identified as an independent risk factor for overall mortality (p=ns). Independent risk factors for overall mortality after AVR were age >80 years (HR 1.6, p<0.001), NYHA class IV (HR 1.4, p=0.006), preoperative AF (HR 1.71, p<0.0001), diabetes mellitus (HR 1.35, p=0.023), preoperative renal failure (HR 4.2, p<0.001), peripheral vascular disease (HR 1.68, p=0.001) and concomitant CABG (HR 1.39, p=0.006).  Figure 3.2 Kaplan-Meier plots representing overall survival of patients with and without PPM. No patient required repeated surgery during follow-up owing to prosthetic structural valve deterioration (SVD) (Paper III). One patient with a Medtronic Mosaic bioprosthesis underwent prosthetic explant during the follow-up period because of prosthetic valve endocarditis with a subvalvular abscess, but no sign of SVD was seen perioperatively. Independent risk factors for late mortality after AVR in this study were preoperative diastolic dysfunction (pseudonormalization; HR 3.6), severe postoperative LVH (HR 8.8), preoperative cerebrovascular insult (HR 5.9), preoperative myocardial infarction (HR 3.2), preoperative LVEF 0.30 to 0.50 (HR 4.7), preoperative NYHA class IV (HR 4.0), postoperative dialysis (HR 28.0), and re-operation for bleeding (HR 5.2). The actuarial survival at 2 years was 91.4% 2.7 for patients receiving the Sorin Soprano prosthesis and 90.5% 2.9 for patients receiving the Medtronic Mosaic prosthesis (p=0.476). Multivariable proportional hazard regression analysis for risk factors affecting overall survival after AVR demonstrated no significant difference in survival between the patients receiving the two different prostheses (p=0.480). The survival rates at 1, 2 and 5 years in the final study (Paper IV) were 90.2% 4.2, 79.7% 5.8 and 71.3% 6.9 for the PPM group and 97.2% 1.3, 95.8% 1.5 and 89.3% 3.0 for the non-PPM group, respectively, p=0.001 (Figure 3.3). Following adjustment for confounding factors using Cox multivariate analysis, no significant difference in survival could be demonstrated between patients with PPM and those without PPM, p=0.23. Implantation of a stented bioprosthesis (HR 4.1), greater age (HR 1.07) and CPB time (HR 1.01) were found to be independent predictors of mortality. The overall survival rates for the whole study population at 1, 2 and 5 years were 95.6%1.4, 92.1%1.8 and 85.1%2.9, respectively. Four patients demonstrated signs of SVD with prosthetic calcification during follow-up. Two of the patients required repeat surgery and explantation during follow-up due to prosthetic endocarditis.  Figure 3.3 Unadjusted overall survival of patients with severe aortic insufficiency following AVR (non-PPM and PPM) 4.8 Postoperative appearance of BNP and the relation between BNP and PPM Patients with PHF had a mean BNP value on arrival at the ICU (D0) of 379 417 pg/mL (median 270 pg/mL ranging from 22-1940), whereas the mean BNP value for patients without PHF was 207 274 (median 100 pg/mL, ranging from 8-1800; p<0.001). Patients with PHF showed a significantly higher increase in BNP level on the first postoperative day (D1) than those without PHF (mean increase of 362 552 pg/mL vs. 78 169 pg/mL, p<0.001). Patients with preoperative NYHA classes III/IV had significantly higher mean BNP levels on arrival at the ICU (D0 = 335 375 pg/mL) than patients in NYHA classes I/II (D0 = 136 184 pg/mL; p<0.001). The BNP level on arrival at the ICU showed a weak but significant linear relationship to the preoperative LV ejection fraction (r = 0.471, p<0.001).There was no significant correlation between PPM and BNP on arrival at the ICU (r = -0.053, p=0.511). Discussion The term valve prosthesispatient mismatch was introduced by Rahimtoola in 1978 to describe a condition in which the in vivo prosthetic valve EOA is smaller than that of the native valve  ADDIN REFMGR.CITE Rahimtoola1978306The problem of valve prosthesis-patient mismatchJournal306The problem of valve prosthesis-patient mismatchRahimtoola,S.H.1978adverse effectsanatomy & histologyConstriction,PathologicetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart ValvesHemodynamic ProcessesHumanspathologyphysiopathologyNot in File2024Circulation58PM:348341Circulation1(1). According to this broad definition, every patient with a prosthetic heart valve has PPM because the leaflets of both mechanical and bioprosthetic valves are mounted on frames that occupy space in the periphery of the valve where the loss of effective orifice is greater than in its central portion. This loss of EOA may or may not be clinically significant, depending on the size and type of prosthetic valve implanted. However, as with native heart valve disease, the thresholds between normal valve orifice and pathophysiologically important stenosis are quite broad, and the clinical and hemodynamic consequences are variable. Generally, patients with a native aortic valve area of less than 1.0 cm2 (0.5-0.6 cm2/m2 based on BSA 1.6-1.9 m2) who have a mean transvalvular gradient greater than 40 mmHg are judged to have severe aortic stenosis in the presence of normal cardiac output  ADDIN REFMGR.CITE Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(63). Most patients with this degree of AS remain asymptomatic for many years and their likelihood of survival is good as long as they remain symptom free  ADDIN REFMGR.CITE Pellikka199045The natural history of adults with asymptomatic, hemodynamically significant aortic stenosisJournal45The natural history of adults with asymptomatic, hemodynamically significant aortic stenosisPellikka,P.A.Nishimura,R.A.Bailey,K.R.Tajik,A.J.1990AdultAgedAged,80 and overAortaAortic ValveAortic Valve StenosisBlood Flow VelocityDeath,SuddendiagnosisEchocardiographyEchocardiography,DopplerElectrocardiography,AmbulatoryetiologyFemaleFollow-Up StudiesHeart CatheterizationHemodynamicsHumansMaleMiddle AgedmortalityphysiologyphysiopathologyReoperationStroke VolumeSurvival RateSyncopetherapyNot in File10121017J Am.Coll.Cardiol.15
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
PM:2312954J Am.Coll.Cardiol.1Rosenhek200078Predictors of outcome in severe, asymptomatic aortic stenosisJournal78Predictors of outcome in severe, asymptomatic aortic stenosisRosenhek,R.Binder,T.Porenta,G.Lang,I.Christ,G.Schemper,M.Maurer,G.Baumgartner,H.2000AdultAgedAortic ValveAortic Valve StenosisDisease ProgressionFemaleFollow-Up StudiesHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityMultivariate AnalysisphysiopathologyPrognosisProspective StudiesRisksurgerySurvival AnalysisultrasonographyNot in File611617N Engl J Med343
Department of Cardiology, Vienna General Hospital, and Ludwig Boltzmann Institute for Cardiovascular Research, Austria
PM:10965007The New England Journal of MedicineN Engl J Med1(62;167). However, the valve area at which individuals become symptomatic is quite variable  ADDIN REFMGR.CITE Otto199780Prospective Study of Asymptomatic Valvular Aortic Stenosis : Clinical, Echocardiographic, and Exercise Predictors of OutcomeJournal80Prospective Study of Asymptomatic Valvular Aortic Stenosis : Clinical, Echocardiographic, and Exercise Predictors of OutcomeOtto,Catherine M.Burwash,Ian G.Legget,Malcolm E.Munt,Brad I.Fujioka,MichelleHealy,Nancy L.Kraft,Carol D.Miyake-Hull,Carolyn Y.Schwaegler,Rebecca G.1997AdultAortic ValvebloodBlood PressureCardiac OutputExercisemethodsPressureProspective StudiesStroke VolumesurgeryNot in File22622270Circulation95http://circ.ahajournals.org/cgi/content/abstract/95/9/2262Circulation1(168), and there is no agreement on what constitutes a severe aortic valve area index. A valve area index of 0.45 cm/m has been suggested to be helpful in defining severity in some cases  ADDIN REFMGR.CITE Carabello20091Aortic stenosisJournal1Aortic stenosisCarabello,B.A.Paulus,W.J.2009AgingAngioplasty,Transluminal,Percutaneous CoronaryAortic Valve StenosisBiological MarkersCalcinosisCardiac OutputcomplicationsetiologyFemaleHeart CatheterizationHeart Valve ProsthesisHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMalepathologyPhysical ExaminationphysiopathologySurvival AnalysisSyncopetherapeutic usetherapyNot in File956966Lancet373
Baylor College of Medicine, Department of Medicine and Veterans Affairs Medical Center, Houston, TX, USA
PM:19232707Lancet1(120), although this threshold has to date not been evaluated. Prosthetic valve stenosis (i.e., PPM) should intuitively not behave differently if similar degrees of LV obstruction are present. Because all prosthetic heart valves are inherently stenotic, a certain degree of obstruction should be harmful to the patient. Therefore, we asked the question: do obstructive prosthetic valves increase operative mortality and morbidity, impair LV remodeling, or affect survival after AVR? 5.1 Postoperative morbidity In Paper I, PPM was identified as an independent risk factor for postoperative neurological events, including stroke, RIND and TIA. A considerable number of elderly patients develop perioperative neurological complications following AVR  ADDIN REFMGR.CITE Ngaage2008355Early neurological complications after coronary artery bypass grafting and valve surgery in octogenariansJournal355Early neurological complications after coronary artery bypass grafting and valve surgery in octogenariansNgaage,D.L.Cowen,M.E.Griffin,S.Guvendik,L.Cale,A.R.2008AgedcomplicationsCoronary Artery BypassFemaleHeartIncidencemethodsmortalityOdds RatioRisk FactorssurgeryNot in File653659European Journal of Cardio-Thoracic Surgery3310107940European Journal of Cardio-Thoracic Surgery1(169). These complications range from subtle cognitive dysfunction to more evident postoperative confusion, delirium, and less commonly, clinically apparent stroke. One explanation of our finding may be the more cumbersome surgical procedure in a small aortic root with extensive calcification, which is commonly observed in patients with native valvular stenosis  ADDIN REFMGR.CITE Fearn2001346Cerebral injury during cardiopulmonary bypass: Emboli impair memoryJournal346Cerebral injury during cardiopulmonary bypass: Emboli impair memoryFearn,S.J.Pole,R.Wesnes,K.Faragher,E.B.Hooper,T.L.McCollum,C.N.2001methodssurgeryNot in File11501160The Journal of Thoracic and Cardiovascular Surgery12100225223The Journal of Thoracic and Cardiovascular Surgery1(170). A more hypothetical explanation may be that post-prosthetic turbulence caused by PPM leads to shear stress in a surgically manipulated and vulnerable ascending aorta, and that these shear forces may cause rupture of calcified plaques adjacent to cannulation sites and the aortotomy, causing embolic debris  ADDIN REFMGR.CITE Likosky2003348Determination of Etiologic Mechanisms of Strokes Secondary to Coronary Artery Bypass Graft SurgeryJournal348Determination of Etiologic Mechanisms of Strokes Secondary to Coronary Artery Bypass Graft SurgeryLikosky,Donald S.Marrin,Charles A.S.Caplan,Louis R.Baribeau,Yvon R.Morton,Jeremy R.Weintraub,Ronald M.Hartman,Gregg S.Hernandez,Felix,Jr.Braff,Steven P.Charlesworth,David C.Malenka,David J.Ross,Cathy S.O'Connor,Gerald T.2003Coronary Artery BypassdiagnosisetiologymethodssurgeryNot in File28302834Stroke34http://stroke.ahajournals.org/cgi/content/abstract/34/12/2830Stroke1(171). Furthermore, it has previously been postulated that shear stress induces platelet activation, causing adherence to atheromatous plaques on vessel walls, with subsequent embolization  ADDIN REFMGR.CITE Ruggeri199325Mechanisms of shear-induced platelet adhesion and aggregationJournal25Mechanisms of shear-induced platelet adhesion and aggregationRuggeri,Z.M.1993Blood ViscosityCell CommunicationHumansphysiologyPlatelet AdhesivenessPlatelet AggregationStress,MechanicalNot in File119123Thromb Haemost.70
Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, CA 92037
PM:8236086Thromb Haemost.1(172). Weinstein postulated that end-hole aortic cannulas direct a high-velocity jet at the left carotid orifice, and may be responsible for a proportion of perioperative strokes and postoperative neurological dysfunction  ADDIN REFMGR.CITE Weinstein2001349Left hemispheric strokes in coronary surgery: implications for end-hole aortic cannulasJournal349Left hemispheric strokes in coronary surgery: implications for end-hole aortic cannulasWeinstein,Gerald S.2001surgeryNot in File128132Ann Thorac Surg71http://www.sciencedirect.com/science/article/B6T11-4234814-14/2/374a55696ede05e052c3a3cb3815cc33The Annals of Thoracic SurgeryAnn Thorac Surg1(173). Similarly, an increased transvalvular velocity and higher gradients secondary to PPM may induce shear stress on the atheromatous aorta. Although postoperative neurological complications following AVR have multiple etiologies, the present findings suggest that PPM may be of relevance for this particular outcome. The adequacy of the multivariate analysis was supported by an AUC of 0.8 (CI 0.75-0.85) and a p-value in the Hosmer-Lemeshow test of 0.84, indicating an accurate and well-calibrated statistical model. Furthermore, PPM had the second highest odds ratio, as verified by both backward and forward stepwise logistical regression analysis. Previous studies addressing the influence of PPM on postoperative morbidity are scare. Adams et al. ADDIN REFMGR.CITE Adams1999345Impact of small prosthetic valve size on operative mortality in elderly patients after aortic valve replacement for aortic stenosis: Does gender matter?Journal345Impact of small prosthetic valve size on operative mortality in elderly patients after aortic valve replacement for aortic stenosis: Does gender matter?Adams,D.H.Chen,R.H.Kadner,A.Aranki,S.F.Allred,E.N.Cohn,L.H.1999Aortic stenosisAortic ValveAortic valve replacementMalemethodsmortalityOdds RatioNot in File815822Journal of thoracic and cardiovascular surgery11800225223Journal of thoracic and cardiovascular surgery1(153), reported a trend towards prolonged ICU stay in relation to PPM (OR 1.8, 95% CI 0.99-3.5, p=0.05). A small valve did not appear to increase the risk of any other of the investigated morbidities although a number of them occurred infrequently. Because AVR is conducted in an increasingly aged population, with several co-morbidities, these patients may be at increased risk of developing LCOS during the postoperative period. Pharmacological support for LCOS is often required during and after weaning from cardiopulmonary bypass, and this acute deterioration in LV function may continue into the intensive care unit  ADDIN REFMGR.CITE Gillies200584Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewJournal84Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewGillies,MichaelBellomo,RinaldoDoolan,LaurieBuxton,Brian2005AdultCardiac Outputdrug therapyHeartIncidencePressuresurgerySyndrometherapyNot in File266279Critical Care91364-853510.1186/cc3024Critical Care1(51). Mismatch results in an elevated residual LV afterload inducing increased myocardial metabolism in an already unfavorable postoperative metabolic state following CPB. Hence, PPM would in theory cause a prolonged need for inotropic support as well as prolonged ICU stay. However, following adjustment for confounding postoperative variables, surprisingly, neither of these two complications were found to be significant in Paper I. Vanky et al.  ADDIN REFMGR.CITE Vanky200685Myocardial metabolism before and after valve replacement for aortic stenosisJournal85Myocardial metabolism before and after valve replacement for aortic stenosisVanky,F.B.Hakanson,E.Szabo,Z.Jorfeldt,L.Svedjeholm,R.2006AgedAmino AcidsAortic ValveAortic Valve StenosisBiological MarkersbloodBlood GlucoseEnergy MetabolismFatty Acids,NonesterifiedFemaleGlycerolHeartHeart FailureHeart Valve Prosthesis ImplantationHemodynamicsHumansLactic AcidMalemetabolismmethodsMiddle AgedMyocardiumOxygenOxygen ConsumptionphysiopathologyPostoperative CarePreoperative CaresurgeryTreatment OutcomeNot in File305313J Cardiovasc Surg (Torino)47
Department of Cardiothoracic Surgery, Linkoping Heart Center, University Hospital, Linkoping, Sweden
PM:16760867J Cardiovasc Surg (Torino)1(174) have previously demonstrated that in patients with aortic stenosis the high preoperative myocardial oxygen extraction ratio of 64% decreased to 52% following AVR. Accordingly, myocardial oxygen consumption decreased by almost 20% (although the latter did not reach statistical significance). The authors speculated that the decrease in myocardial oxygen extraction was mainly explained by the unloading impact of AVR on myocardial workload. These findings support the statement that PPM may not be important in the immediate postoperative clinical setting following AVR with respect to cardiac-related complications. 5.2 Impact of PPM on early mortality Previous studies have identified several independent predictors of early mortality in relation to AVR  ADDIN REFMGR.CITE Sakamoto2006336Prevalence and avoidance of patient-prosthesis mismatch in aortic valve replacement in small adultsJournal336Prevalence and avoidance of patient-prosthesis mismatch in aortic valve replacement in small adultsSakamoto,Y.Hashimoto,K.Okuyama,H.Takakura,H.Ishii,S.Taguchi,S.Kagawa,H.2006AdolescentAdultAgedAged,80 and overAortic ValveAortic valve replacementBody SizeBody Surface AreaFemaleHeart Valve ProsthesisHumansMalemethodsMiddle AgedPrevalenceProsthesis DesignReference ValuesRetrospective Studiesstandardsstatistics & numerical datasurgerySurvival RateTime FactorsNot in File13051309Ann Thorac Surg81
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan
PM:16564262The Annals of Thoracic SurgeryAnn Thorac Surg1Flameng2006339Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valveJournal339Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valveFlameng,W.Meuris,B.Herijgers,P.Herregods,M.C.2006adverse effectsAgedAged,80 and overAortic ValveAortic valve replacementBioprosthesisEchocardiographyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansHypertrophyHypertrophy,Left VentricularIncidenceMalemethodsMiddle AgedmortalityMultivariate AnalysisProsthesis FittingsurgerytherapyNot in File530536Ann Thorac Surg82
Department of Cardiac Surgery, University Clinic Gasthuisberg, Leuven, Belgium. willem.flameng@med.kuleuven.be
PM:16863756file://H:\Dokument\Publications on PPM\Flameng-Annals 2006.pdfThe Annals of Thoracic SurgeryAnn Thorac Surg1Blais20033Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementJournal3Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementBlais,C.Dumesnil,J.G.Baillot,R.Simard,S.Doyle,D.Pibarot,P.2003adverse effectsAgedAortic ValveBody SizeCohort StudiesepidemiologyFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansIntraoperative PeriodMalemortalityMultivariate AnalysisOdds RatioOutcome Assessment (Health Care)physiopathologyPostoperative PeriodProspective StudiesQuebecReference ValuesResearch Support,Non-U.S.Gov'tRisk AssessmentRisk Factorsstandardsstatistics & numerical dataStroke VolumesurgeryTimeVascular PatencyNot in File983988Circulation108
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada
PM:12912812Circulation1Hanayama200214Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantJournal14Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantHanayama,N.Christakis,G.T.Mallidi,H.R.Joyner,C.D.Fremes,S.E.Morgan,C.D.Mitoff,P.R.Goldman,B.S.2002AdultAgedAnthropometryAortic ValveepidemiologyetiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedPostoperative ComplicationsPrevalenceProspective StudiesProsthesis Designstatistics & numerical datasurgerySurvival RateNot in File18221829Ann.Thorac.Surg.73
Division of Cardiovascular Surgery of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
PM:12078776file://H:\Dokument\Publications on PPM\HanayamaPPM is rare after AVR.pdfAnn.Thorac.Surg.1(12;45;57;158). Similar risk factors, such as high age and preoperative AF, were identified in Paper I. Neither severe nor moderate PPM was found to be an independent risk factor for increased 30-day mortality. The reported effects of PPM on early mortality following AVR vary; some studies have found impaired survival  ADDIN REFMGR.CITE Blais20033Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementJournal3Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementBlais,C.Dumesnil,J.G.Baillot,R.Simard,S.Doyle,D.Pibarot,P.2003adverse effectsAgedAortic ValveBody SizeCohort StudiesepidemiologyFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansIntraoperative PeriodMalemortalityMultivariate AnalysisOdds RatioOutcome Assessment (Health Care)physiopathologyPostoperative PeriodProspective StudiesQuebecReference ValuesResearch Support,Non-U.S.Gov'tRisk AssessmentRisk Factorsstandardsstatistics & numerical dataStroke VolumesurgeryTimeVascular PatencyNot in File983988Circulation108
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada
PM:12912812Circulation1Rao2000307Prosthesis-patient mismatch affects survival after aortic valve replacementJournal307Prosthesis-patient mismatch affects survival after aortic valve replacementRao,V.Jamieson,W.R.Ivanov,J.Armstrong,S.David,T.E.2000adverse effectsAortic ValveBioprosthesisBody Surface AreaepidemiologyFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHumansIntraoperative PeriodmortalityPostoperative ComplicationsProportional Hazards ModelsProsthesis FittingstandardssurgerySurvival AnalysisSurvival RateTimeNot in FileIII5III9Circulation102
Division of Cardiovascular Surgery of Toronto General Hospital, Toronto, Ontario, M5G 2C4, Canada
PM:11082354Circulation1(12;175), while others were not able to demonstrate any negative influence  ADDIN REFMGR.CITE Medalion2000310Aortic valve replacement: is valve size important?Journal310Aortic valve replacement: is valve size important?Medalion,B.Blackstone,E.H.Lytle,B.W.White,J.Arnold,J.H.Cosgrove,D.M.2000AdolescentAdultAgedAortic ValveAortic Valve StenosisBiocompatible MaterialsBioprosthesisComparative StudyepidemiologyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedmortalityProsthesis DesignReproducibility of ResultsRetrospective StudiesRisk FactorsstandardssurgerySurvival RatetransplantationTransplantation,HomologousTreatment OutcomeNot in File963974J.Thorac.Cardiovasc.Surg.119
Department of Thoracic and Cardiovascular Surgery and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
PM:10788817J.Thorac.Cardiovasc.Surg.1Howell2006329Patient-prosthesis mismatch does not affect survival following aortic valve replacementJournal329Patient-prosthesis mismatch does not affect survival following aortic valve replacementHowell,N.J.Keogh,B.E.Barnet,V.Bonser,R.S.Graham,T.R.Rooney,S.J.Wilson,I.C.Pagano,D.2006Adultadverse effectsAgedAged,80 and overAortic ValveAortic valve replacementBody Surface AreaEpidemiologic MethodsFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalitypathologyProsthesis DesignProsthesis FittingsurgeryTreatment OutcomeNot in File1014Eur.J Cardiothorac.Surg30
Department of Cardiothoracic Surgery, University Hospital NHS Foundation Trust, Birmingham, UK
PM:16723251Eur.J Cardiothorac.Surg1Hanayama200214Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantJournal14Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantHanayama,N.Christakis,G.T.Mallidi,H.R.Joyner,C.D.Fremes,S.E.Morgan,C.D.Mitoff,P.R.Goldman,B.S.2002AdultAgedAnthropometryAortic ValveepidemiologyetiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedPostoperative ComplicationsPrevalenceProspective StudiesProsthesis Designstatistics & numerical datasurgerySurvival RateNot in File18221829Ann.Thorac.Surg.73
Division of Cardiovascular Surgery of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
PM:12078776file://H:\Dokument\Publications on PPM\HanayamaPPM is rare after AVR.pdfAnn.Thorac.Surg.1(45;58;65). AVR offers an immediate reduction in afterload on the LV, as well as reduced myocardial workload and a dramatic improvement of the LV ejection fraction  ADDIN REFMGR.CITE Carabello200489Is it ever too late to operate on the patient with valvular heart disease?Journal89Is it ever too late to operate on the patient with valvular heart disease?Carabello,Blase A.2004HeartNot in File376383Journal of the American College of Cardiology440735-1097doi: DOI: 10.1016/j.jacc.2004.03.061http://www.sciencedirect.com/science/article/B6T18-4CW4HG2-11/2/bba1ecb8372f4120cc8b50b2cb603965Journal of the American College of Cardiology1(176). On this basis, the logical implications would be that small residual transprosthetic gradients should not have a significant impact on early mortality. 5.3 Postoperative heart failure Despite improvements in surgical techniques and myocardial protection in the field of cardiac surgery, pharmacological support for low cardiac output syndrome is often required during and after weaning from cardiopulmonary bypass, and the acute deterioration in ventricular function may continue into the intensive care unit  ADDIN REFMGR.CITE Gillies200584Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewJournal84Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewGillies,MichaelBellomo,RinaldoDoolan,LaurieBuxton,Brian2005AdultCardiac Outputdrug therapyHeartIncidencePressuresurgerySyndrometherapyNot in File266279Critical Care91364-853510.1186/cc3024Critical Care1(51). In spite of the serious and critical consequences of postoperative heart failure, there is no consensus regarding what constitutes LCOS with the existential data mainly derived from studies on CABG patients. Definitions include low cardiac output (cardiac index <2.4 L/min/m2) with evidence of organ dysfunction  ADDIN REFMGR.CITE Gillies200584Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewJournal84Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewGillies,MichaelBellomo,RinaldoDoolan,LaurieBuxton,Brian2005AdultCardiac Outputdrug therapyHeartIncidencePressuresurgerySyndrometherapyNot in File266279Critical Care91364-853510.1186/cc3024Critical Care1(51), use of more than four inotropic drugs, left ventricular assist device or IABP  ADDIN REFMGR.CITE Shernan200490Impact of pexelizumab, an anti-C5 complement antibody, on total mortality and adverse cardiovascular outcomes in cardiac surgical patients undergoing cardiopulmonary bypassJournal90Impact of pexelizumab, an anti-C5 complement antibody, on total mortality and adverse cardiovascular outcomes in cardiac surgical patients undergoing cardiopulmonary bypassShernan,S.K.Fitch,J.C.Nussmeier,N.A.Chen,J.C.Rollins,S.A.Mojcik,C.F.Malloy,K.J.Todaro,T.G.Filloon,T.Boyce,S.W.Gangahar,D.M.Goldberg,M.Saidman,L.J.Mangano,D.T.2004administration & dosageadverse effectsAntibodies,MonoclonalArteriesbloodCardiopulmonary BypassCardiovascular DiseasesComplement ActivationComplement C5Coronary Artery BypassCreatine KinaseCreatine Kinase,MB FormDouble-Blind Methoddrug effectsetiologyHeart Valve Prosthesis ImplantationHumansimmunologyInflammationInfusions,IntravenousInjections,IntravenousIsoenzymesmethodsmortalityMyocardial InfarctionpharmacologyProspective StudiessurgerytherapyVentricular Dysfunction,LeftNot in File942949Ann Thorac Surg77
Division of Cardiothoracic Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii, USA. shernan@zeus.bwh.harvard.edu
PM:14992903The Annals of Thoracic SurgeryAnn Thorac Surg1(177), and the requirement for postoperative IABP or inotropic support for >30 min to maintain arterial blood pressure above 90 mmHg or CO >2.2 L/min  ADDIN REFMGR.CITE Maganti2005126Predictors of Low Cardiac Output Syndrome After Isolated Aortic Valve SurgeryJournal126Predictors of Low Cardiac Output Syndrome After Isolated Aortic Valve SurgeryMaganti,Manjula D.Rao,VivekBorger,Michael A.Ivanov,JoanDavid,Tirone E.2005analysisAortic ValveCardiac OutputFemaleHeart FailuremethodsmortalityOdds RatioRegression AnalysissurgeryNot in FileI448Circulation112http://circ.ahajournals.org/cgi/content/abstract/112/9_suppl/I-448Circulation1(88). Causes of LCOS are multifactorial, but include myocardial ischemia during cross-clamping, reperfusion injury, cardioplegia-induced myocardial dysfunction, activation of inflammatory and coagulation cascades, and unreversed preexisting cardiac disease. Organ dysfunction and multiple organ failure are among the main causes of prolonged hospital stay after cardiac surgery, with subsequent increases in the use of resources and health care costs, as well as increasing morbidity and mortality  ADDIN REFMGR.CITE Gillies200584Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewJournal84Bench-to-bedside review: Inotropic drug therapy after adult cardiac surgery - a systematic literature reviewGillies,MichaelBellomo,RinaldoDoolan,LaurieBuxton,Brian2005AdultCardiac Outputdrug therapyHeartIncidencePressuresurgerySyndrometherapyNot in File266279Critical Care91364-853510.1186/cc3024Critical Care1(51). Therefore, optimization of cardiac output and oxygen delivery through early recognition of LCOS may improve clinical outcome as well as decrease health care costs. Studies addressing causes and risk factors for LCOS following AVR are sparse, although postoperative heart failure remains an important predictor of poor outcome  ADDIN REFMGR.CITE Maganti2005126Predictors of Low Cardiac Output Syndrome After Isolated Aortic Valve SurgeryJournal126Predictors of Low Cardiac Output Syndrome After Isolated Aortic Valve SurgeryMaganti,Manjula D.Rao,VivekBorger,Michael A.Ivanov,JoanDavid,Tirone E.2005analysisAortic ValveCardiac OutputFemaleHeart FailuremethodsmortalityOdds RatioRegression AnalysissurgeryNot in FileI448Circulation112http://circ.ahajournals.org/cgi/content/abstract/112/9_suppl/I-448Circulation1Vanky2007137Long-term consequences of postoperative heart failure after surgery for aortic stenosis compared with coronary surgeryJournal137Long-term consequences of postoperative heart failure after surgery for aortic stenosis compared with coronary surgeryVanky,F.B.Hakanson,E.Svedjeholm,R.2007adverse effectsAgedAged,80 and overAortic stenosisAortic ValveAortic Valve StenosisAtrial FibrillationCoronary Artery BypassetiologyFemaleHeart FailureHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityRisk FactorsStrokesurgerySurvivalSurvival AnalysisSwedenTime FactorsNot in File20362043Ann.Thorac Surg83
Department of Cardiothoracic Surgery, University Hospital, Linkoping, Sweden
PM:17532392Ann.Thorac Surg1Vanky2006138Risk factors for postoperative heart failure in patients operated on for aortic stenosisJournal138Risk factors for postoperative heart failure in patients operated on for aortic stenosisVanky,F.B.Hakanson,E.Tamas,E.Svedjeholm,R.2006AgedanalysisAortic stenosisAortic ValveAortic Valve StenosisepidemiologyFemaleHeart FailureHumansMalemethodsmortalityMyocardial InfarctionPostoperative ComplicationsRegression AnalysisRisk FactorssurgerySwedenNot in File12971304Ann.Thorac Surg81
Department of Cardiothoracic Surgery, University Hospital, Linkoping, Sweden
PM:16564261Ann.Thorac Surg1(88-90). The results presented in Paper II showed that the 30-day mortality was more than 10-fold higher (8.1% vs. 0.8%) in patients with postoperative heart failure. The association between PHF and 30-day mortality emphasizes the importance of early diagnosis and the initiation of adequate therapy in the ICU. In Paper II, we found that an elevated BNP level on arrival at the ICU is an independent predictor of postoperative heart failure after AVR. Because the secretion of BNP is rapid and the half-life short (T1/2 = 20 minutes)  ADDIN REFMGR.CITE Daniels2007100Natriuretic PeptidesJournal100Natriuretic PeptidesDaniels,Lori B.Maisel,Alan S.2007Not in File23572368Journal of the American College of Cardiology50http://www.sciencedirect.com/science/article/B6T18-4RCW571-5/2/652fc1b8f3d647fba77be6ef44cd99f1Journal of the American College of Cardiology1(99), BNP levels reflect acute changes in LV wall stress. Furthermore, Morimoto et al.  ADDIN REFMGR.CITE Morimoto1998118Perioperative changes in plasma brain natriuretic peptide concentrations in patients undergoing cardiac surgeryJournal118Perioperative changes in plasma brain natriuretic peptide concentrations in patients undergoing cardiac surgeryMorimoto,K.Mori,T.Ishiguro,S.Matsuda,N.Hara,Y.Kuroda,H.1998AdultbloodCardiac Surgical ProceduresCardiopulmonary BypassFemaleHeart FailureHemodynamicsHumansIntraoperative PeriodMaleMiddle AgedNatriuretic Peptide,BrainNerve Tissue ProteinsphysiologyPostoperative PeriodProspective StudiesStroke VolumesurgeryTime FactorsVentricular functionVentricular Function,LeftNot in File2329Surg Today28
Second Department of Surgery, Tottori University Faculty of Medicine, Japan
PM:9505313Surg Today1(163) have shown that BNP levels do not change during CPB and remain unchanged 6 hours after weaning from bypass. Therefore, the analysis of postoperative BNP levels measured immediately on arrival in the ICU could theoretically provide valuable information regarding the current myocardial status. However, it must be emphasized that as a single variable, the predictive value of an increased BNP level was relatively weak (AUC = 0.69). These results are similar to the findings of Provenchere et al.  ADDIN REFMGR.CITE Provenchere20063Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortalityJournal3Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortalityProvenchere,S.Berroeta,C.Reynaud,C.Baron,G.Poirier,I.Desmonts,J.M.Iung,B.Dehoux,M.Philip,I.Benessiano,J.2006adverse effectsAgedanalysisbloodCardiac Surgical ProceduresCardiopulmonary BypassetiologyFemaleHeart DiseasesHumansMaleMiddle AgedmortalityMultivariate AnalysisNatriuretic Peptide,BrainPrognosisProspective StudiesRisk AssessmentsurgeryTime FactorsTroponinTroponin INot in File9951000Crit Care Med.34
Departement d'Anesthesie-Reanimation-Chirurgicale, Groupe Hospitalier Bichat-Claude Bernard (AP-HP), Faculte Xavier Bichat (Universite Paris 7), France
PM:16484891H:\Dokument\PEK III\ArtiklarCrit Care Med.1(113), who found an elevated BNP level on the first postoperative day to be a predictor of postoperative cardiac dysfunction within 5 days of cardiac surgery. At present, a wide range of threshold values of BNP and its precursor Nt-proBNP is used to predict symptoms and LCOS onset in various studies, preventing any cutoff from being sufficiently able to aid clinical management  ADDIN REFMGR.CITE Cerrahoglu2007152N-terminal ProBNP levels can predict cardiac failure after cardiac surgeryJournal152N-terminal ProBNP levels can predict cardiac failure after cardiac surgeryCerrahoglu,M.Iskesen,I.Tekin,C.Onur,E.Yildirim,F.Sirin,B.H.2007AgedbloodCardiac OutputCardiac Output,LowCardiotonic AgentscomplicationsCoronary Artery BypassCoronary Artery Diseasedrug therapyetiologyFemaleHumansMalemethodsMiddle AgedNatriuretic Peptide,BrainPeptide FragmentsphysiologyphysiopathologyPostoperative PeriodPredictive Value of TestsPrognosisStroke Volumesurgerytherapeutic useVentricular Dysfunction,LeftNot in File7983Circ.J71
Department of Cardiovascular Surgery, Celal Bayar University School of Medicine, Manisa, Turkey
PM:17186982Circ.J1Cuthbertson200529Utility of B-type natriuretic peptide in predicting the level of peri- and postoperative cardiovascular support required after coronary artery bypass graftingJournal29Utility of B-type natriuretic peptide in predicting the level of peri- and postoperative cardiovascular support required after coronary artery bypass graftingCuthbertson,B.H.McKeown,A.Croal,B.L.Mutch,W.J.Hillis,G.S.2005AgedbloodCardiotonic AgentscomplicationsCoronary Artery BypassdiagnosisFemaleHeart-Assist DevicesHumansLength of StayMaleMiddle AgedNatriuretic Peptide,BrainPerioperative CarePostoperative ComplicationsPredictive Value of TestsSensitivity and Specificitysurgerytherapeutic useTroponinTroponin INot in File437442Crit Care Med33
Anaesthesia and Intensive Care, Medicine and Therapeutics, Medical School, University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK
PM:15699850Crit Care Med1Provenchere20063Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortalityJournal3Plasma brain natriuretic peptide and cardiac troponin I concentrations after adult cardiac surgery: association with postoperative cardiac dysfunction and 1-year mortalityProvenchere,S.Berroeta,C.Reynaud,C.Baron,G.Poirier,I.Desmonts,J.M.Iung,B.Dehoux,M.Philip,I.Benessiano,J.2006adverse effectsAgedanalysisbloodCardiac Surgical ProceduresCardiopulmonary BypassetiologyFemaleHeart DiseasesHumansMaleMiddle AgedmortalityMultivariate AnalysisNatriuretic Peptide,BrainPrognosisProspective StudiesRisk AssessmentsurgeryTime FactorsTroponinTroponin INot in File9951000Crit Care Med.34
Departement d'Anesthesie-Reanimation-Chirurgicale, Groupe Hospitalier Bichat-Claude Bernard (AP-HP), Faculte Xavier Bichat (Universite Paris 7), France
PM:16484891H:\Dokument\PEK III\ArtiklarCrit Care Med.1Hutfless200498Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryJournal98Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryHutfless,R.Kazanegra,R.Madani,M.Bhalla,M.A.Tulua-Tata,A.Chen,A.Clopton,P.James,C.Chiu,A.Maisel,A.S.2004AgedbloodCardiac Surgical ProcedurescomplicationsHeart DiseasesHumansLength of StayMaleMiddle AgedmortalityNatriuretic Peptide,BrainPerioperative CarePostoperative ComplicationsPredictive Value of TestsRisk AssessmentsurgeryTreatment OutcomeNot in File18731879J.Am.Coll.Cardiol.43
University of California, San Diego, San Diego, California, USA
PM:15145114http://www.sciencedirect.com.ludwig.lub.lu.se/science?_ob=MImg&_imagekey=B6T18-4CCF2G1-W-9&_cdi=4884&_user=745831&_orig=search&_coverDate=05%2F19%2F2004&_sk=999569989&view=c&wchp=dGLbVlb-zSkWW&_valck=1&md5=21a385ff42398bbbc722df9cfdb1bae4&ie=/sdarticle.pdfJ.Am.Coll.Cardiol.1Bergler-Klein20046Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosisJournal6Natriuretic peptides predict symptom-free survival and postoperative outcome in severe aortic stenosisBergler-Klein,J.Klaar,U.Heger,M.Rosenhek,R.Mundigler,G.Gabriel,H.Binder,T.Pacher,R.Maurer,G.Baumgartner,H.2004AgedAged,80 and overanalysisAortic stenosisAortic ValveAortic Valve StenosisAtrial Natriuretic FactorBiological MarkersbloodcomplicationsDisease ProgressionDisease-Free SurvivalDyspneaetiologyFemaleHeart FailureHeart Valve Prosthesis ImplantationHumansLife TablesMalemethodsMiddle AgedmortalityMultivariate AnalysisNatriuretic Peptide,BrainNerve Tissue ProteinsPeptide FragmentsPrognosisProspective StudiesProtein PrecursorsSeverity of Illness IndexSingle-Blind Methodstatistics & numerical dataStroke VolumesurgerySurvivalTreatment OutcomeultrasonographyVentricular functionNot in File23022308Circulation109
Department of Cardiology and the Ludwig Boltzmann Institute of Cardiovascular Research, University of Vienna, Vienna, Austria
PM:15117847Circulation1(107;112;113;178;179). Furthermore, the presence of renal disease  ADDIN REFMGR.CITE Tsutamoto2006154Relationship between renal function and plasma brain natriuretic peptide in patients with heart failureJournal154Relationship between renal function and plasma brain natriuretic peptide in patients with heart failureTsutamoto,T.Wada,A.Sakai,H.Ishikawa,C.Tanaka,T.Hayashi,M.Fujii,M.Yamamoto,T.Dohke,T.Ohnishi,M.Takashima,H.Kinoshita,M.Horie,M.2006AgedBiological MarkersblooddiagnosisFemaleGlomerular Filtration RateHeartHeart FailureHumansMalemethodsMiddle AgedNatriuretic Peptide,BrainphysiopathologyPrognosisStroke VolumeVentricular PressureNot in File582586J Am.Coll.Cardiol.47
Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan. tutamoto@belle.shiga-med.ac.jp
PM:16458140J Am.Coll.Cardiol.1(180), pulmonary hypertension  ADDIN REFMGR.CITE Ando199625Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in patients with chronic respiratory diseasesJournal25Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in patients with chronic respiratory diseasesAndo,T.Ogawa,K.Yamaki,K.Hara,M.Takagi,K.1996AgedAged,80 and overAtrial Natriuretic FactorbloodChronic DiseaseElectrocardiographyEndothelinsFemaleHeartHumansMalemetabolismMiddle AgedNatriuretic Peptide,BrainNatriuretic Peptide,C-TypeNatriuretic PeptidesNerve Tissue ProteinsOxygenOxygen Inhalation TherapyphysiopathologyProteinsRespiratory Tract DiseasestherapyNot in File462468Chest110
Second Department of Internal Medicine, Nagoya University School of Medicine, Japan
PM:8697852Chest1(181), and obesity  ADDIN REFMGR.CITE Horwich2006153B-type natriuretic peptide levels in obese patients with advanced heart failureJournal153B-type natriuretic peptide levels in obese patients with advanced heart failureHorwich,T.B.Hamilton,M.A.Fonarow,G.C.2006Biological MarkersbloodBody Mass IndexcomplicationsFemaleHeart FailureHeart TransplantationHemodynamicsHumansMalemethodsMiddle AgedmortalityNatriuretic Peptide,BrainObesityphysiopathologyPredictive Value of TestsPrognosisStroke VolumeSurvivalNot in File8590J Am.Coll.Cardiol.47
Ahmanson-UCLA Cardiomyopathy Center, UCLA Division of Cardiology, Los Angeles, California 90095-1679, USA
PM:16386669J Am.Coll.Cardiol.1(182) may all interfere with the predictive value of BNP measurements. Using ROC analysis, we found that a BNP level of >82 pg/mL on admittance to the ICU may be an important threshold for diagnosing postoperative heart failure after AVR (Paper II). A similar level of BNP (80 pg/mL) has previously been evaluated and reported as a relevant cutoff level for the diagnosis of preoperative heart failure  ADDIN REFMGR.CITE de Lemos2001130The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromesJournal130The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromesde Lemos,J.A.Morrow,D.A.Bentley,J.H.Omland,T.Sabatine,M.S.McCabe,C.H.Hall,C.Cannon,C.P.Braunwald,E.2001Acute DiseaseAgedanalysisAngina,UnstableAtrial Natriuretic FactorbloodC-Reactive ProteincomplicationsetiologyFemaleHeart FailureHumansMalemethodsMiddle AgedmortalityMyocardial InfarctionNatriuretic Peptide,BrainOdds RatioPrognosisRandomized Controlled Trials as TopicRegression AnalysisRisk AssessmentStatistics,NonparametricNot in File10141021N.Engl.J.Med.345
Thrombolysis in Myocardial Infarction Study Group, Boston, USA. james.delemos@utsouthwestern.edu
PM:11586953N.Engl.J.Med.1Dao200199Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care settingJournal99Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care settingDao,QuyenKrishnaswamy,PadmaKazanegra,RadmilaHarrison,AlexAmirnovin,RambodLenert,LeslieClopton,PaulAlberto,JoelHlavin,PatriciaMaisel,Alan S.2001analysisbloodMaleMultivariate AnalysisNot in File379385Journal of the American College of Cardiology37http://www.sciencedirect.com/science/article/B6T18-4299XNK-2/2/eb176d3e96313d11431d84f6780c5841Journal of the American College of Cardiology1Berendes2004117A-Type and B-Type Natriuretic Peptides in Cardiac Surgical ProceduresJournal117A-Type and B-Type Natriuretic Peptides in Cardiac Surgical ProceduresBerendes,ElmarSchmidt,ChristophVan Aken,HugoHartlage,Maike GrosseRothenburger,MarkusWirtz,StefanScheld,Hans HeinrichBrodner,GerhardWalter,Michael2004Cardiac Surgical ProceduresCoronary Artery BypassmortalitysurgeryTroponinTroponin INot in File1119Anesth Analg98http://www.anesthesia-analgesia.org/cgi/content/abstract/98/1/11Anesthesia AnalgesiaAnesth Analg1(104;183;184). However, a low cutoff may lead to an unnecessarily aggressive therapeutic approach and would therefore be of limited clinical value. Berendes et al.  ADDIN REFMGR.CITE Berendes2004117A-Type and B-Type Natriuretic Peptides in Cardiac Surgical ProceduresJournal117A-Type and B-Type Natriuretic Peptides in Cardiac Surgical ProceduresBerendes,ElmarSchmidt,ChristophVan Aken,HugoHartlage,Maike GrosseRothenburger,MarkusWirtz,StefanScheld,Hans HeinrichBrodner,GerhardWalter,Michael2004Cardiac Surgical ProceduresCoronary Artery BypassmortalitysurgeryTroponinTroponin INot in File1119Anesth Analg98http://www.anesthesia-analgesia.org/cgi/content/abstract/98/1/11Anesthesia AnalgesiaAnesth Analg1(184) found that the baseline BNP levels in patients with valve disease were increased, and, therefore, we also chose to evaluate the hypothetically more useful median BNP level of 133 pg/mL. This cutoff level was also predictive of PHF, leading to a higher specificity in terms of identifying patients with LCOS. Hutfless et al.  ADDIN REFMGR.CITE Hutfless200498Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryJournal98Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgeryHutfless,R.Kazanegra,R.Madani,M.Bhalla,M.A.Tulua-Tata,A.Chen,A.Clopton,P.James,C.Chiu,A.Maisel,A.S.2004AgedbloodCardiac Surgical ProcedurescomplicationsHeart DiseasesHumansLength of StayMaleMiddle AgedmortalityNatriuretic Peptide,BrainPerioperative CarePostoperative ComplicationsPredictive Value of TestsRisk AssessmentsurgeryTreatment OutcomeNot in File18731879J.Am.Coll.Cardiol.43
University of California, San Diego, San Diego, California, USA
PM:15145114http://www.sciencedirect.com.ludwig.lub.lu.se/science?_ob=MImg&_imagekey=B6T18-4CCF2G1-W-9&_cdi=4884&_user=745831&_orig=search&_coverDate=05%2F19%2F2004&_sk=999569989&view=c&wchp=dGLbVlb-zSkWW&_valck=1&md5=21a385ff42398bbbc722df9cfdb1bae4&ie=/sdarticle.pdfJ.Am.Coll.Cardiol.1(112) have previously shown that elevated peak BNP levels postoperatively and increased maximum change in BNP levels were associated with prolonged hospital stay and increased 1-year mortality after cardiac surgery. However, the reliability of their conclusions was limited by the small number of patients undergoing AVR (n = 19) and the fact that no multivariate analysis was performed. In another study, Skidmore et al  ADDIN REFMGR.CITE Skidmore20044Brain natriuretic peptide: a diagnostic and treatment hormone for perioperative congestive heart failureJournal4Brain natriuretic peptide: a diagnostic and treatment hormone for perioperative congestive heart failureSkidmore,K.L.Russell,I.A.2004adverse effectsBiological Markersblooddiagnosisdiagnostic usedrug therapyEchocardiographyHeart FailureHumansmethodsNatriuretic AgentsNatriuretic Peptide,BrainPerioperative Caresurgerytherapeutic useNot in File780787J.Cardiothorac.Vasc.Anesth18
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143-0427, USA. skidmore@anesthesia.ucsf.edu
PM:15650995J.Cardiothorac.Vasc.Anesth1(185) suggested that failure of BNP to improve postoperatively indicates ongoing heart failure. The findings presented in Paper II revealed similar results, with a significantly higher change in the mean BNP level from arrival in the ICU to postoperative day 1 in patients with PHF, than in patients without heart failure. In the present work (Paper II), prolonged CPB time and positive operative fluid balance were also found to be independent predictors of postoperative heart failure. Both variables may reflect higher surgical complexity and a technically more demanding procedure. COPD was also identified as an independent predictor of postoperative heart failure. BNP has been reported to play an important role in the development of COPD, particularly in the presence of right heart overloading. COPD may result in pulmonary hypertension  ADDIN REFMGR.CITE Han2007133Pulmonary Diseases and the HeartJournal133Pulmonary Diseases and the HeartHan,MeiLan K.McLaughlin,Vallerie V.Criner,Gerard J.Martinez,Fernando J.2007classificationPrognosisNot in File29923005Circulation116http://circ.ahajournals.org/cgi/content/abstract/116/25/2992Circulation1(186) causing right ventricle dysfunction and secondary secretion of BNP  ADDIN REFMGR.CITE Passino2005134Right heart overload contributes to cardiac natriuretic hormone elevation in patients with heart failureJournal134Right heart overload contributes to cardiac natriuretic hormone elevation in patients with heart failurePassino,ClaudioMaria Sironi,AnnaFavilli,BrunellaPoletti,RobertaProntera,ConcettaRipoli,AndreaLombardi,MassimoEmdin,Michele2005Heart FailureHormonesMagnetic resonance imagingNatriuretic PeptidesNot in File3945International Journal of Cardiology104http://www.sciencedirect.com/science/article/B6T16-4FJKWVG-2/2/d77c6e3195c688096d69101474a55d44International Journal of Cardiology1Ando199625Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in patients with chronic respiratory diseasesJournal25Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in patients with chronic respiratory diseasesAndo,T.Ogawa,K.Yamaki,K.Hara,M.Takagi,K.1996AgedAged,80 and overAtrial Natriuretic FactorbloodChronic DiseaseElectrocardiographyEndothelinsFemaleHeartHumansMalemetabolismMiddle AgedNatriuretic Peptide,BrainNatriuretic Peptide,C-TypeNatriuretic PeptidesNerve Tissue ProteinsOxygenOxygen Inhalation TherapyphysiopathologyProteinsRespiratory Tract DiseasestherapyNot in File462468Chest110
Second Department of Internal Medicine, Nagoya University School of Medicine, Japan
PM:8697852Chest1(181;187). However, pulmonary hypertension was not identified as an independent predictor of PHF in the present work, although this may reflect the relatively low number of patients with pulmonary hypertension and requires further evaluation. Neither a preoperative LVEF >50% nor LVEF > 30% predicted PHF independently. This finding may reflect the immediate beneficial effect of AVR, i.e. afterload reduction, but also underlines the importance of additional diagnostic tools for predicting PHF. Based on the findings reported in Paper II, BNP should not be considered a replacement for a postoperative echocardiographic examination of the patient, but as an additional diagnostic tool and prognostic marker. 5.4 Impact of PPM on diastolic heart failure Diastolic heart failure (defined as pseudonormalization or restrictive filling), in the absence of impaired LV ejection fraction, was present in nearly half of the patients (Paper III). Preoperative LV mass index was significantly higher in this group than in the patients with normal diastolic dysfunction and those with impaired relaxation (p=0.008). Persistent LVH is one of the known causes of DHF  ADDIN REFMGR.CITE Fischer2003354Prevalence of left ventricular diastolic dysfunction in the community: Results from a Doppler echocardiographic-based survey of a population sampleJournal354Prevalence of left ventricular diastolic dysfunction in the community: Results from a Doppler echocardiographic-based survey of a population sampleFischer,M.Baessler,A.Hense,H.W.Hengstenberg,C.Muscholl,M.Holmer,S.Doring,A.Broeckel,U.Riegger,G.Schunkert,H.2003AgedEchocardiographyRisk FactorsNot in File320328Eur Heart J24http://eurheartj.oxfordjournals.org/cgi/content/abstract/24/4/320European Heart JournalEur Heart J1(96) and the pre-existence of advanced LVH has been demonstrated to be a major obstacle for LVMR despite otherwise successful AVR  ADDIN REFMGR.CITE Bove2006356Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcomeJournal356Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcomeBove,ThierryVan Belleghem,YvesFrancois,KatrienCaes,FrankVan Overbeke,HansVan Nooten,Guido2006Aortic ValveAortic valve replacementBioprosthesisLeft ventricular mass regressionmortalityStentless prosthesisNot in File706713European Journal of Cardio-Thoracic Surgery30http://www.sciencedirect.com/science/article/B6T35-4KTVP15-2/2/09c9b102ce9d4aa01b63f5d142005735European Journal of Cardio-Thoracic Surgery1(72). Therefore, the presence of PPM would intuitively have a negative impact on the recovery of diastolic function. However, no significant relation could be demonstrated between impaired recovery of DHF and PPM. Previous studies have demonstrated that the regression of LV mass after AVR peaks after 1 year  ADDIN REFMGR.CITE Lund199756Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanismsJournal56Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanismsLund,O.Flo,C.Jensen,F.T.Emmertsen,K.Nielsen,T.T.Rasmussen,B.S.Hansen,O.K.Pilegaard,H.K.Kristensen,L.H.1997AdultAgedAged,80 and overAortic ValveAortic valve replacementAortic Valve StenosisFemaleHeart Valve Prosthesis ImplantationHumansLogistic ModelsMaleMiddle AgedModels,CardiovascularModels,StatisticalmortalityphysiopathologyPrognosisProspective StudiesRisk FactorssurgerySurvival AnalysisVentricular Function,LeftNot in File19771987Eur Heart J18
Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark
PM:9447328European Heart JournalEur Heart J1(84), and that the degree of DHF may deteriorate up to 10 years postoperatively, despite significant LVMR  ADDIN REFMGR.CITE Gjertsson2005359Preoperative moderate to severe diastolic dysfunction: A novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosisJournal359Preoperative moderate to severe diastolic dysfunction: A novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosisGjertsson,PeterCaidahl,KennethFarasati,MahmoodOden,AndersBech-Hanssen,Odd2005EchocardiographymortalityNot in File890896Journal of Thoracic and Cardiovascular Surgery129http://www.sciencedirect.com/science/article/B6WMF-4FWFR5W-1D/2/d7497c65a2a8546b247d4b05b0b341d7Journal of Thoracic and Cardiovascular Surgery1(95). The findings reported in Paper III are limited by the exclusive use of echocardiographic techniques for the diagnosis of diastolic abnormalities and the fact that the follow-up period was relatively short. Therefore, we cannot rule out that a longer follow-up period might provide further information regarding diastolic remodeling for patients undergoing aortic valve replacement. In a recent study, Brown et al.  ADDIN REFMGR.CITE Brown200995Interaction and Prognostic Effects of Left Ventricular Diastolic Dysfunction and Patient-Prosthesis Mismatch as Determinants of Outcome After Isolated Aortic Valve ReplacementJournal95Interaction and Prognostic Effects of Left Ventricular Diastolic Dysfunction and Patient-Prosthesis Mismatch as Determinants of Outcome After Isolated Aortic Valve ReplacementBrown,J.Shah,P.Stanton,T.Marwick,T.H.2009Aortic ValveBody Surface AreaEchocardiographyHeartmortalityPressureNot in File707712The American Journal of Cardiology10400029149The American Journal of Cardiology1(188) evaluated a small series of patients undergoing AVR for various reasons using projected EOA, despite having echocardiographic data available. PPM was not predictive of death or total cardiac events over an intermediate follow-up period of 3 years. However, persisting diastolic dysfunction was associated with PPM, and cardiac events were significantly associated with the presence of diastolic dysfunction, independent of PPM. Survival was particularly decreased in patients with more severe classes of diastolic heart failure. These findings stand in contrast to our results, but underline the clinical relevance of DHF as an important variable before and following AVR. 5.5 Stented bioprostheses for supra-annular implantation Third-generation bioprostheses designed for complete supra-annular implantation offer a means of avoiding PPM, as the stent is positioned such that the disturbance of aortic blood flow will potentially be less. Garcia and associates  ADDIN REFMGR.CITE Garcia Fuster2007352Prosthesis patient mismatch with latest generation supra-annular prostheses. The beginning of the end?Journal352Prosthesis patient mismatch with latest generation supra-annular prostheses. The beginning of the end?Garcia Fuster,RafaelEstevez,VanesaRodriguez,IgnacioCanovas,SergioGil,OscarHornero,FernandoMartinez-Leon,Juan2007mortalityNot in File462469Interact CardioVasc Thorac Surg6http://icvts.ctsnetjournals.org/cgi/content/abstract/6/4/462Interactive CardioVascular and Thoracic SurgeryInteract CardioVasc Thorac Surg1(71) demonstrated that PPM after AVR is a predictor of late cardiac death and poor early survival for patients with increased LV mass index, but concluded that the incidence of PPM was reduced with the use of the latest generation of supraannular prostheses. In Paper III, we assessed the Sorin Soprano prosthesis, a third-generation pericardial bioprosthesis available for commercial use in Europe since 2003. This bioprosthesis is implanted in the supra-annular position and may therefore be of advantage in patients with small aortic annuli  ADDIN REFMGR.CITE Pavoni20061Results of Aortic Valve Replacement With a New Supra-Annular Pericardial Stented BioprosthesisJournal1Results of Aortic Valve Replacement With a New Supra-Annular Pericardial Stented BioprosthesisPavoni,DaisyBadano,Luigi P.Musumeci,Sergio F.Frassani,RomeoGianfagna,PasqualeMazzaro,EnzoLivi,Ugolino2006Not in File21332138The Annals of Thoracic Surgery82http://www.sciencedirect.com/science/article/B6T11-4MD7RR2-18/2/1d42a475668ebd12dc894f43e415dcaeH:\Dokument\PEK II\ArtiklarThe Annals of Thoracic Surgery1Gerosa2006345Small aortic annulus: The hydrodynamic performances of 5 commercially available tissue valvesJournal345Small aortic annulus: The hydrodynamic performances of 5 commercially available tissue valvesGerosa,GinoTarzia,VincenzoRizzoli,GiulioBottio,Tomaso2006Not in File1058The Journal of Thoracic and Cardiovascular Surgery131http://www.sciencedirect.com/science/article/B6WMF-4JW7C4P-X/2/de66f17c932c17408c090fd944335536The Journal of Thoracic and Cardiovascular Surgery1(162;189). We found a high incidence of severe PPM (39.8%) and no similar incidence figures have been reported previously. In contrast, previous studies have demonstrated lower transvalvular gradients and a low incidence of PPM when using the Sorin Soprano valve  ADDIN REFMGR.CITE Pavoni20061Results of Aortic Valve Replacement With a New Supra-Annular Pericardial Stented BioprosthesisJournal1Results of Aortic Valve Replacement With a New Supra-Annular Pericardial Stented BioprosthesisPavoni,DaisyBadano,Luigi P.Musumeci,Sergio F.Frassani,RomeoGianfagna,PasqualeMazzaro,EnzoLivi,Ugolino2006Not in File21332138The Annals of Thoracic Surgery82http://www.sciencedirect.com/science/article/B6T11-4MD7RR2-18/2/1d42a475668ebd12dc894f43e415dcaeH:\Dokument\PEK II\ArtiklarThe Annals of Thoracic Surgery1Garcia Fuster2007352Prosthesis patient mismatch with latest generation supra-annular prostheses. The beginning of the end?Journal352Prosthesis patient mismatch with latest generation supra-annular prostheses. The beginning of the end?Garcia Fuster,RafaelEstevez,VanesaRodriguez,IgnacioCanovas,SergioGil,OscarHornero,FernandoMartinez-Leon,Juan2007mortalityNot in File462469Interact CardioVasc Thorac Surg6http://icvts.ctsnetjournals.org/cgi/content/abstract/6/4/462Interactive CardioVascular and Thoracic SurgeryInteract CardioVasc Thorac Surg1(71;162). However, despite the high incidence of PPM in our study, similar results have been found regarding postoperative transprosthetic gradients, EOAs, and degree of LVMR in other previously published reports  ADDIN REFMGR.CITE Botzenhardt20052Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic AnnulusJournal2Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic AnnulusBotzenhardt,FlorianEichinger,Walter B.Bleiziffer,SabineGuenzinger,RalfWagner,Ina M.Bauernschmitt,RobertLange,Ruediger2005Not in File20542060Journal of the American College of Cardiology45http://www.sciencedirect.com/science/article/B6T18-4G7X9MR-9/2/3bdbcc4575188faaddc74368b94bcbf3H:\Dokument\PEK II\ArtiklarJournal of the American College of Cardiology1Dalmau2007348One year hemodynamic performance of the Perimount Magna pericardial xenograft and the Medtronic Mosaic bioprosthesis in the aortic position: a prospective randomized studyJournal348One year hemodynamic performance of the Perimount Magna pericardial xenograft and the Medtronic Mosaic bioprosthesis in the aortic position: a prospective randomized studyDalmau,Maria JoseMaria Gonzalez-Santos,JoseLopez-Rodriguez,JavierBueno,MariaArribas,AntonioNieto,Felix2007Aortic ValveBioprosthesisNot in File345349Interact CardioVasc Thorac Surg6http://icvts.ctsnetjournals.org/cgi/content/abstract/6/3/345Interactive CardioVascular and Thoracic SurgeryInteract CardioVasc Thorac Surg1(151;190). Furthermore, despite a high incidence, PPM was not found to be a significant predictor of impaired LVMR, regardless of severity. Improvements in hemodynamic outcome reached statistical significance only at the larger prosthetic sizes, and this finding is in accord with a previous study by Botzenhardt and associates  ADDIN REFMGR.CITE Botzenhardt20052Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic AnnulusJournal2Hemodynamic Comparison of Bioprostheses for Complete Supra-Annular Position in Patients With Small Aortic AnnulusBotzenhardt,FlorianEichinger,Walter B.Bleiziffer,SabineGuenzinger,RalfWagner,Ina M.Bauernschmitt,RobertLange,Ruediger2005Not in File20542060Journal of the American College of Cardiology45http://www.sciencedirect.com/science/article/B6T18-4G7X9MR-9/2/3bdbcc4575188faaddc74368b94bcbf3H:\Dokument\PEK II\ArtiklarJournal of the American College of Cardiology1(151). Overall, our study demonstrated favorable LVMR and excellent clinical outcome for the Sorin Soprano bioprostheses. The choice of in vivo EOA in Paper III was based on an editorial by Rahimtoola  ADDIN REFMGR.CITE Rahimtoola2006332Is severe valve prosthesis-patient mismatch (VP-PM) associated with a higher mortality?Journal332Is severe valve prosthesis-patient mismatch (VP-PM) associated with a higher mortality?Rahimtoola,Shahbudin H.2006mortalityNot in File1European Journal of Cardio-Thoracic Surgery30http://ejcts.ctsnetjournals.orgEuropean Journal of Cardio-Thoracic Surgery1(191) following the publication of two studies reporting conflicting results concerning the influence of PPM on early and late mortality  ADDIN REFMGR.CITE Howell2006329Patient-prosthesis mismatch does not affect survival following aortic valve replacementJournal329Patient-prosthesis mismatch does not affect survival following aortic valve replacementHowell,N.J.Keogh,B.E.Barnet,V.Bonser,R.S.Graham,T.R.Rooney,S.J.Wilson,I.C.Pagano,D.2006Adultadverse effectsAgedAged,80 and overAortic ValveAortic valve replacementBody Surface AreaEpidemiologic MethodsFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalitypathologyProsthesis DesignProsthesis FittingsurgeryTreatment OutcomeNot in File1014Eur.J Cardiothorac.Surg30
Department of Cardiothoracic Surgery, University Hospital NHS Foundation Trust, Birmingham, UK
PM:16723251Eur.J Cardiothorac.Surg1Walther2006333Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacementJournal333Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacementWalther,ThomasRastan,ArdawanFalk,VolkmarLehmann,SvenGarbade,JensFunkat,Anne K.Mohr,Friedrich W.Gummert,Jan F.2006Aortic ValveAortic valve replacementBody Surface AreamethodsmortalityRegression AnalysisRisk FactorssurgerySurvival AnalysisNot in File1519European Journal of Cardio-Thoracic Surgery30http://ejcts.ctsnetjournals.org/cgi/content/abstract/30/1/15European Journal of Cardio-Thoracic Surgery1(64;65). Rahimtoola suggested the following measures in order to be able to address the issue of mortality in patients with PPM correctly: 1. Prosthetic EOA should be calculated from echocardiographic/Doppler studies, at 6 and/or 12 months after AVR  ADDIN REFMGR.CITE Rahimtoola200377Choice of prosthetic heart valve for adult patientsJournal77Choice of prosthetic heart valve for adult patientsRahimtoola,S.H.2003AdultAortic ValveBioprosthesiscomplicationsEndocarditisHeartMitral ValvemortalityNot in File893904Journal of the American College of Cardiology4107351097Journal of the American College of Cardiology1(192); 2. severe PPM should be defined as EOAi d" 0.6 cm2/m2 as it is not possible to measure with any degree of precision to a hundredth of a centimeter  ADDIN REFMGR.CITE <Refman><Cite><Author>Rahimtoola</Author><Year>2003</Year><RecNum>77</RecNum><IDText>Choice of prosthetic heart valve for adult patientsJournal77Choice of prosthetic heart valve for adult patientsRahimtoola,S.H.2003AdultAortic ValveBioprosthesiscomplicationsEndocarditisHeartMitral ValvemortalityNot in File893904Journal of the American College of Cardiology4107351097Journal of the American College of Cardiology1(192); and 3. the cause of death should be determined by a blinded committee, or in an adjudicative manner, regardless of whether death is due to cardiac causes related to a prosthetic heart valve, cardiac causes not related to a prosthetic heart valve, or non-cardiac causes. 5.6 Impact of PPM on LV remodeling in aortic valve insufficiency Measures suggested to prevent PPM and to tailor surgical strategies appear to be same, regardless of the procedure and underlying etiology causing valve replacement  ADDIN REFMGR.CITE Pibarot200966Prosthetic heart valves: selection of the optimal prosthesis and long-term managementJournal66Prosthetic heart valves: selection of the optimal prosthesis and long-term managementPibarot,P.Dumesnil,J.G.2009Not in File10341048Circulation119
Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V-4G5. philippe.pibarot@med.ulaval.ca or medjgd@hermes.ulaval.ca
PM:19237674Circulation1(38). Previous studies have demonstrated that PPM is most likely to occur in patients in whom the predominant lesion was aortic stenosis, as the calcified aortic valve and aortic root present a surgical challenge for the implantation of a prosthetic valve with an adequate EOA  ADDIN REFMGR.CITE Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1(9). Because aortic insufficiency often presents with annular dilatation and an absence of valve calcification, this condition could intuitively be believed to be unrelated to PPM. However, the results in Paper IV suggest that PPM may occur in up to 22% of the patient population undergoing surgery for severe aortic insufficiency. Although this lesion has been included in the analysis in earlier reports  ADDIN REFMGR.CITE Bridges200765Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacementJournal65Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacementBridges,C.R.O'Brien,S.M.Cleveland,J.C.Savage,E.B.Gammie,J.S.Edwards,F.H.Peterson,E.D.Grover,F.L.2007AdultAgedAged,80 and overaortic valveAortic valve replacementBody Surface AreaFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansinstrumentationMalemethodsMiddle AgedmortalityProsthesis DesignsurgeryNot in File10121021J Thorac Cardiovasc Surg133
Department of Surgery, the University of Pennsylvania Health System, Philadelphia, Pa, USA. cbridges@pahosp.com
PM:17382644J Thorac Cardiovasc Surg1(42), until recently, no previous studies had focused on the possible influence of PPM on LV remodeling in severe AVI. Aortic valve insufficiency with preoperative impairment of LVEF and increased LVESD has a predicted annual mortality of 10-20% in the absence of surgical intervention  ADDIN REFMGR.CITE Borer199176Natural history of left ventricular performance at rest and during exercise after aortic valve replacement for aortic regurgitationJournal76Natural history of left ventricular performance at rest and during exercise after aortic valve replacement for aortic regurgitationBorer,J.S.Herrold,E.M.Hochreiter,C.Roman,M.Supino,P.Devereux,R.B.Kligfield,P.Nawaz,H.1991Aortic ValveAortic Valve InsufficiencyCineangiographyepidemiologyExerciseFollow-Up StudiesHeartHeart Valve ProsthesisHumansphysiologyphysiopathologyRadionuclide Angiographyradionuclide imagingsurgeryTime FactorsVentricular Function,LeftNot in FileIII133III139Circulation84
Cardiology Division, New York Hospital-Cornell Medical Center, NY 10021
PM:1934401Circulation1(140). It has also been demonstrated that preoperatively impaired LVEF and increased LVEDD are two of the most important determinants of survival and recovery of LV function following valve surgery  ADDIN REFMGR.CITE Bonow198867Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitationJournal67Long-term serial changes in left ventricular function and reversal of ventricular dilatation after valve replacement for chronic aortic regurgitationBonow,R.O.Dodd,J.T.Maron,B.J.O'Gara,P.T.White,G.G.McIntosh,C.L.Clark,R.E.Epstein,S.E.1988AdultAgedaortic valveAortic Valve InsufficiencyAortic valve replacementCardiomegalyDiastoleEchocardiographyFemaleFollow-Up StudiesHumansMaleMiddle AgedpathologyphysiopathologyRadionuclide AngiographyStroke VolumesurgerySystoleNot in File11081120Circulation78
Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892
PM:2972417Circulation1Bhudia20074Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunctionJournal4Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunctionBhudia,S.K.McCarthy,P.M.Kumpati,G.S.Helou,J.Hoercher,K.J.Rajeswaran,J.Blackstone,E.H.2007AdultAgedaortic valveAortic Valve InsufficiencyChronic DiseasecomplicationsFemaleHumansMaleMiddle AgedmortalityRisk FactorsSeverity of Illness IndexsurgerySurvival RateTreatment OutcomeVentricular Dysfunction,LeftNot in File14651471J Am Coll Cardiol49
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
PM:17397676J Am Coll Cardiol1Duarte199768Late survival after valve operation in patients with left ventricular dysfunctionJournal68Late survival after valve operation in patients with left ventricular dysfunctionDuarte,I.G.Murphy,C.O.Kosinski,A.S.Jones,E.L.Craver,J.M.Gott,J.P.Guyton,R.A.1997AdolescentAdultAgedAged,80 and overaortic valvecomplicationsCoronary Artery BypassFemaleFollow-Up StudiesHeart Valve DiseasesHeart Valve Prosthesis ImplantationHospital MortalityHumansLogistic ModelsMalemethodsMiddle AgedMitral ValvemortalityMultivariate AnalysisRegression AnalysisReoperationRisk FactorssurgerySurvival AnalysisSurvivorsVentricular Dysfunction,LeftNot in File10891095Ann Thorac Surg64
Carlyle Fraser Heart Center, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30365-2225, USA
PM:9354533Ann Thorac Surg1(193-195). The volume overload on the left ventricle in AVI is resolved following AVR, but in the presence of PPM it has been suggested that it is replaced by an increase in the transprosthetic gradient  ADDIN REFMGR.CITE Rahimtoola1978306The problem of valve prosthesis-patient mismatchJournal306The problem of valve prosthesis-patient mismatchRahimtoola,S.H.1978adverse effectsanatomy & histologyConstriction,PathologicetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart ValvesHemodynamic ProcessesHumanspathologyphysiopathologyNot in File2024Circulation58PM:348341Circulation1(1). Theoretically, PPM could lead to impaired restoration of LV dimensions as the afterload on the left ventricle and pressure gradient are increased. However, the present findings suggest that the transprosthetic gradients do not influence the postoperative LV remodeling negatively, as the recovery rates of LV dimensions were comparable in both groups. On the contrary, the present findings, suggest that the residual gradient resulting from the prosthesis is more than compensated for by the relief of the excessive work load on the left ventricle through AVR. The presence of PPM was associated with a significantly higher transprosthetic gradient in two of the present studies (Paper III and IV). In Paper IV, no significant impact of PPM is reported regarding the recovery of LVEF or LVH regression. In patients with poor preoperative LV function (LVEF less than 50%), the LVEF improved to a great extent in both groups, regardless of PPM. This finding is supported by a previous study by Chaliki et al.  ADDIN REFMGR.CITE Chaliki200261Outcomes After Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Markedly Reduced Left Ventricular FunctionJournal61Outcomes After Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Markedly Reduced Left Ventricular FunctionChaliki,Hari P.Mohty,DaniaAvierinos,Jean FrancoisScott,Christopher G.Schaff,Hartzell V.Tajik,A.JamilEnriquez-Sarano,Maurice2002aortic valvemethodsmortalityNot in File26872693Circulation106http://circ.ahajournals.org/cgi/content/abstract/106/21/2687Circulation1(196), who demonstrated a significant postoperative improvement in LVEF in patients with aortic insufficiency and poor preoperative LV function. Furthermore, Carroll et al.  ADDIN REFMGR.CITE Carroll1983352Serial changes in left ventricular function after correction of chronic aortic regurgitation. Dependence on early changes in preload and subsequent regression of hypertrophyJournal352Serial changes in left ventricular function after correction of chronic aortic regurgitation. Dependence on early changes in preload and subsequent regression of hypertrophyCarroll,J.D.Gaasch,W.H.Zile,M.R.Levine,H.J.1983Aortic Valve InsufficiencyBlood PressureCardiomegalyChronic DiseasecomplicationsEchocardiographyHeart Valve ProsthesisHeart VentriclesHumansHypertrophyphysiopathologyStroke VolumesurgerySystoleNot in File476482Am J Cardiol51PM:6218744Am J Cardiol1(197) and Lamb et al.  ADDIN REFMGR.CITE Lamb20021Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitationJournal1Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitationLamb,H.J.Beyerbacht,H.P.de,Roos A.van der,Laarse A.Vliegen,H.W.Leujes,F.Bax,J.J.van der Wall,E.E.2002AdultAgedAortic ValveAortic Valve InsufficiencyAortic valve replacementAortic Valve StenosisBlood Flow VelocityComparative StudydiagnosisDiastoleFemaleHeart Valve ProsthesisHumansHypertrophyLeft ventricular massLeft ventricular mass indexMagnetic Resonance ImagingMaleMiddle AgedObserver VariationphysiologyphysiopathologysurgeryVentricular Function,LeftVentricular RemodelingNot in File21822188J Am Coll Cardiol40
Department of Radiology, Leiden University Medical Center, The Netherlands. H.J.Lamb@lumc.nl
PM:12505232Journal of the American College of CardiologyJ Am Coll Cardiol1(70) found that the LVEDD and LV volumes in patients with aortic insufficiency returned to almost normal values within 2 weeks of AVR, whereas a significant regression of LVH took at least 6 months. They concluded that complete regression of LVH may take many years. Other studies have shown that patients with severely reduced LVEF and preoperatively dilated LV do not exhibit complete regression of LV dimensions following AVR for aortic insufficiency  ADDIN REFMGR.CITE Chaliki200261Outcomes After Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Markedly Reduced Left Ventricular FunctionJournal61Outcomes After Aortic Valve Replacement in Patients With Severe Aortic Regurgitation and Markedly Reduced Left Ventricular FunctionChaliki,Hari P.Mohty,DaniaAvierinos,Jean FrancoisScott,Christopher G.Schaff,Hartzell V.Tajik,A.JamilEnriquez-Sarano,Maurice2002aortic valvemethodsmortalityNot in File26872693Circulation106http://circ.ahajournals.org/cgi/content/abstract/106/21/2687Circulation1Bhudia20074Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunctionJournal4Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunctionBhudia,S.K.McCarthy,P.M.Kumpati,G.S.Helou,J.Hoercher,K.J.Rajeswaran,J.Blackstone,E.H.2007AdultAgedaortic valveAortic Valve InsufficiencyChronic DiseasecomplicationsFemaleHumansMaleMiddle AgedmortalityRisk FactorsSeverity of Illness IndexsurgerySurvival RateTreatment OutcomeVentricular Dysfunction,LeftNot in File14651471J Am Coll Cardiol49
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
PM:17397676J Am Coll Cardiol1(194;196). Current evidence indicates that regression of LVH is a time-consuming process and, therefore, a longer follow-up time may be required to further elucidate the influence of PPM on LVH regression following AVR due to aortic valve insufficiency. 5.7 Impact of PPM on mortality In Paper I, it is reported that crude long-term survival in patients with PPM was impaired compared to those without PPM. The difference, however, was not significant after adjusting for risk factors for overall mortality. Similar findings have been reported in previous studies addressing the effect of PPM on long-term survival  ADDIN REFMGR.CITE Rao2000307Prosthesis-patient mismatch affects survival after aortic valve replacementJournal307Prosthesis-patient mismatch affects survival after aortic valve replacementRao,V.Jamieson,W.R.Ivanov,J.Armstrong,S.David,T.E.2000adverse effectsAortic ValveBioprosthesisBody Surface AreaepidemiologyFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHumansIntraoperative PeriodmortalityPostoperative ComplicationsProportional Hazards ModelsProsthesis FittingstandardssurgerySurvival AnalysisSurvival RateTimeNot in FileIII5III9Circulation102
Division of Cardiovascular Surgery of Toronto General Hospital, Toronto, Ontario, M5G 2C4, Canada
PM:11082354Circulation1Medalion2000310Aortic valve replacement: is valve size important?Journal310Aortic valve replacement: is valve size important?Medalion,B.Blackstone,E.H.Lytle,B.W.White,J.Arnold,J.H.Cosgrove,D.M.2000AdolescentAdultAgedAortic ValveAortic Valve StenosisBiocompatible MaterialsBioprosthesisComparative StudyepidemiologyFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedmortalityProsthesis DesignReproducibility of ResultsRetrospective StudiesRisk FactorsstandardssurgerySurvival RatetransplantationTransplantation,HomologousTreatment OutcomeNot in File963974J.Thorac.Cardiovasc.Surg.119
Department of Thoracic and Cardiovascular Surgery and the Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
PM:10788817J.Thorac.Cardiovasc.Surg.1Pibarot199865Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valveJournal65Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valvePibarot,P.Dumesnil,J.G.Lemieux,M.Cartier,P.Metras,J.Durand,L.G.1998adverse effectsAgedAortic ValveBioprosthesisBody Surface AreaCardiac OutputCohort StudiesComparative StudydiagnosisDisease-Free SurvivalEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHemodynamic ProcessesHumansMaleMiddle AgedmortalityphysiologyphysiopathologyPrognosisProspective StudiesProsthesis FailureProsthesis FittingResearch Support,Non-U.S.Gov'tsurgeryultrasonographyNot in File211218J.Heart Valve Dis.7
Department of Cardiology, Quebec Heart Institute, Ste Foy, Canada
PM:9587864J.Heart Valve Dis.1Frapier2002323Influence of patient-prosthesis mismatch on long-term results after aortic valve replacement with a stented bioprosthesisJournal323Influence of patient-prosthesis mismatch on long-term results after aortic valve replacement with a stented bioprosthesisFrapier,J.M.Rouviere,P.Razcka,F.Aymard,T.Albat,B.Chaptal,P.A.2002Aortic ValveAortic valve replacementBioprosthesisNot in File543551Journal of Heart Valve Disease11http://www.sciencedirect.com/science/article/B6T1G-46HMDF6-2J0/2/5987277644a7399c909a5bf1505e233cJournal of Heart Valve Disease1(7;53;58;175). Blackstone and colleagues  ADDIN REFMGR.CITE Blackstone200376Prosthesis size and long-term survival after aortic valve replacementJournal76Prosthesis size and long-term survival after aortic valve replacementBlackstone,E.H.Cosgrove,D.M.Jamieson,W.R.Birkmeyer,N.J.Lemmer,J.H.,Jr.Miller,D.C.Butchart,E.G.Rizzoli,G.Yacoub,M.Chai,A.2003AgedAlgorithmsAortic ValveBioprosthesisBody Surface AreaFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityProsthesis Designstatistics & numerical datasurgerySurvival RateTime FactorsNot in File783796J.Thorac.Cardiovasc.Surg.126
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA. blackse@ccf.org
PM:14502155J.Thorac.Cardiovasc.Surg.1(43) studied more than 13,000 patients following AVR with a mean follow-up time of 5.3 years, and found no reduction in survival after adjusting for preoperative risk factors. In contrast, both Rao et al.  ADDIN REFMGR.CITE Rao2000307Prosthesis-patient mismatch affects survival after aortic valve replacementJournal307Prosthesis-patient mismatch affects survival after aortic valve replacementRao,V.Jamieson,W.R.Ivanov,J.Armstrong,S.David,T.E.2000adverse effectsAortic ValveBioprosthesisBody Surface AreaepidemiologyFollow-Up StudiesHeart Valve DiseasesHeart Valve ProsthesisHumansIntraoperative PeriodmortalityPostoperative ComplicationsProportional Hazards ModelsProsthesis FittingstandardssurgerySurvival AnalysisSurvival RateTimeNot in FileIII5III9Circulation102
Division of Cardiovascular Surgery of Toronto General Hospital, Toronto, Ontario, M5G 2C4, Canada
PM:11082354Circulation1(175) and Mohty-Echahidi and coworkers  ADDIN REFMGR.CITE Mohty-Echahidi2006334Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic positionJournal334Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic positionMohty-Echahidi,D.Malouf,J.F.Girard,S.E.Schaff,H.V.Grill,D.E.Enriquez-Sarano,M.E.Miller,F.A.,Jr.2006AgedAortic ValveAortic Valve InsufficiencyAortic valve replacementBody Surface AreaEchocardiographyFemaleHeart Failure,CongestiveHeart Valve ProsthesisHumansIncidenceMalemethodsMiddle AgedmortalityMultivariate AnalysisPostoperative ComplicationsPredictive Value of TestsProportional Hazards ModelsRisk Factorsstatistics & numerical dataStroke VolumesurgerySurvival RateultrasonographyNot in File420426Circulation113
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
PM:16415379Circulation1(56) reported that severe PPM had a significant negative impact on long-term survival. These disparate findings may indicate the need to identify a subgroup in a population undergoing AVR in which PPM might have a significant impact on clinical outcome. Several risk factors for early and late mortality after AVR with bioprostheses are presented in Paper III, confirming the findings of previous studies  ADDIN REFMGR.CITE Edwards2001326Prediction of operative mortality after valve replacement surgeryJournal326Prediction of operative mortality after valve replacement surgeryEdwards,Fred H.Peterson,Eric D.Coombs,Laura P.DeLong,Elizabeth R.Jamieson,W.R.E.Shroyer,A.LaurieGrover,Frederick L.2001Aortic ValveAortic valve replacementmethodsMitral ValvemortalityReoperationRisk FactorssurgeryNot in File885892J Am Coll Cardiol37http://content.onlinejacc.org/cgi/content/abstract/37/3/885Journal of the American College of CardiologyJ Am Coll Cardiol1(198). However, neither moderate nor severe PPM was found to be an independent risk factor for increased early or late mortality. Furthermore, no significant differences in clinical outcome could be related to type of prosthesis. Lund and coworkers  ADDIN REFMGR.CITE Lund199756Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanismsJournal56Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanismsLund,O.Flo,C.Jensen,F.T.Emmertsen,K.Nielsen,T.T.Rasmussen,B.S.Hansen,O.K.Pilegaard,H.K.Kristensen,L.H.1997AdultAgedAged,80 and overAortic ValveAortic valve replacementAortic Valve StenosisFemaleHeart Valve Prosthesis ImplantationHumansLogistic ModelsMaleMiddle AgedModels,CardiovascularModels,StatisticalmortalityphysiopathologyPrognosisProspective StudiesRisk FactorssurgerySurvival AnalysisVentricular Function,LeftNot in File19771987Eur Heart J18
Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Denmark
PM:9447328European Heart JournalEur Heart J1(84) have previously reported impaired systolic and diastolic LV function to be independent preoperative predictors of early as well as late mortality after AVR, and suggested the underlying mechanism to be mainly concentric LVH. In contrast, Nakagawa and colleagues  ADDIN REFMGR.CITE Nakagawa2007357Postoperative outcome in aortic stenosis with diastolic heart failure compared to one with depressed systolic functionJournal357Postoperative outcome in aortic stenosis with diastolic heart failure compared to one with depressed systolic functionNakagawa,D.Suwa,M.Ito,T.Kono,T.Kitaura,Y.2007AgedAortic ValveAortic valve replacementAortic Valve StenosiscomplicationsEchocardiography,DoppleretiologyFemaleFollow-Up StudiesHeart CatheterizationHeart Failure,CongestiveHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedMyocardial ContractionphysiologyphysiopathologyPrognosisRetrospective StudiesSeverity of Illness IndexStroke VolumesurgerySystoleTime FactorsTreatment OutcomeultrasonographyVentricular Function,LeftNot in File7986Int.Heart J48
Third Division, Department of Internal Medicine, Osaka Medical College, Daigaku-cho, Takatsuki City, Osaka, Japan
PM:17379981Int.Heart J1(199) found that the occurrence of DHF did not affect postoperative early mortality. In the present study, diastolic dysfunction (pseudonormalization) and preoperative advanced LVH were predictors of late mortality. The divergence in the results of previous studies may reflect differences in the duration of follow-up and thus the dynamic remodeling process, which is initiated by the reduction of LV afterload resulting from AVR  ADDIN REFMGR.CITE Bove2006356Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcomeJournal356Stentless and stented aortic valve replacement in elderly patients: factors affecting midterm clinical and hemodynamical outcomeBove,ThierryVan Belleghem,YvesFrancois,KatrienCaes,FrankVan Overbeke,HansVan Nooten,Guido2006Aortic ValveAortic valve replacementBioprosthesisLeft ventricular mass regressionmortalityStentless prosthesisNot in File706713European Journal of Cardio-Thoracic Surgery30http://www.sciencedirect.com/science/article/B6T35-4KTVP15-2/2/09c9b102ce9d4aa01b63f5d142005735European Journal of Cardio-Thoracic Surgery1Gjertsson2005358Left Ventricular Diastolic Dysfunction Late After Aortic Valve Replacement in Patients With Aortic StenosisJournal358Left Ventricular Diastolic Dysfunction Late After Aortic Valve Replacement in Patients With Aortic StenosisGjertsson,PeterCaidahl,KennethBech-Hanssen,Odd2005Aortic ValveAortic valve replacementEchocardiographyNot in File722727The American Journal of Cardiology96http://www.sciencedirect.com/science/article/B6T10-4GPVXFT-5/2/c9a954a58509f422e55f8c2317ac1975The American Journal of Cardiology1(72;200). The overall survival rates for patients undergoing AVR for severe acute and chronic AVI were 96% at 1 year and 85% at 5 years. The survival in the present work is favorable compared to those reported in previous studies where, depending on the degree of LV dysfunction, 1- and 5-year survival rates vary between 81 and 92%, and 68 and 82%, respectively  ADDIN REFMGR.CITE Bhudia20074Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunctionJournal4Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunctionBhudia,S.K.McCarthy,P.M.Kumpati,G.S.Helou,J.Hoercher,K.J.Rajeswaran,J.Blackstone,E.H.2007AdultAgedaortic valveAortic Valve InsufficiencyChronic DiseasecomplicationsFemaleHumansMaleMiddle AgedmortalityRisk FactorsSeverity of Illness IndexsurgerySurvival RateTreatment OutcomeVentricular Dysfunction,LeftNot in File14651471J Am Coll Cardiol49
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
PM:17397676J Am Coll Cardiol1Tornos20068Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgeryJournal8Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgeryTornos,P.Sambola,A.Permanyer-Miralda,G.Evangelista,A.Gomez,Z.Soler-Soler,J.2006AdolescentAdultAgedaortic valveAortic Valve InsufficiencyChronic DiseaseFemaleFollow-Up StudiesGuideline AdherenceHumansMalemethodsMiddle AgedProspective StudiesSeverity of Illness IndexsurgeryTime FactorsTreatment OutcomeNot in File10121017J Am Coll Cardiol47
Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. ptornos@vhebron.net
PM:16516086J Am Coll Cardiol1(194;201). The improved survival demonstrated in Paper IV could in part be explained by the relatively recent inclusion period. Bhudia et al. ADDIN REFMGR.CITE Bhudia20074Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunctionJournal4Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunctionBhudia,S.K.McCarthy,P.M.Kumpati,G.S.Helou,J.Hoercher,K.J.Rajeswaran,J.Blackstone,E.H.2007AdultAgedaortic valveAortic Valve InsufficiencyChronic DiseasecomplicationsFemaleHumansMaleMiddle AgedmortalityRisk FactorsSeverity of Illness IndexsurgerySurvival RateTreatment OutcomeVentricular Dysfunction,LeftNot in File14651471J Am Coll Cardiol49
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
PM:17397676J Am Coll Cardiol1(194) demonstrated that survival following AVR improved dramatically across their study time frame for patients with aortic insufficiency and LV dysfunction. The survival rate reported in Paper IV was significantly reduced in the presence of PPM, according to univariate analysis. However, in multivariate Cox proportional hazard analysis, only age at surgery (HR 1.07), duration of CPB (HR 1.01) and implantation of a bioprosthesis (HR 4.1) had a significant influence on survival. The age limit for implanting a bioprostheses at our department is around 70 years and therefore these patients naturally have a shorter life expectancy. Inferior hemodynamics and PPM is more likely to occur following implantation of a bioprosthesis than a mechanical prosthesis  ADDIN REFMGR.CITE Pibarot200966Prosthetic heart valves: selection of the optimal prosthesis and long-term managementJournal66Prosthetic heart valves: selection of the optimal prosthesis and long-term managementPibarot,P.Dumesnil,J.G.2009Not in File10341048Circulation119
Laval Hospital Research Center, 2725 Chemin Sainte-Foy, Quebec, Quebec, Canada, G1V-4G5. philippe.pibarot@med.ulaval.ca or medjgd@hermes.ulaval.ca
PM:19237674Circulation1(38). Sequential multivariate analysis was performed to test the statistical model in which bioprosthesis as a variable was excluded. Furthermore, we created a conjugate variable for patients with PPM receiving a stented bioprosthesis. In neither of these sequential steps was PPM found to be a significant predictor of survival. There were differences in baseline patient characteristics between the two groups in Paper IV that may have influenced the results. However, by excluding possible confounders and performing sequential multivariate analysis, the ability of the model to test for the influence of PPM was improved. Prolonged CPB has been demonstrated to be strongly associated with impaired survival in previous studies  ADDIN REFMGR.CITE Tjang200764Predictors of mortality after aortic valve replacementJournal64Predictors of mortality after aortic valve replacementTjang,Yanto Sandyvan Hees,YvonneK÷rfer,ReinerGrobbee,Diederick E.van der Heijden,Geert J.M.G.2007aortic valveAortic valve replacementmortalityPrognosisSystematic reviewNot in File469474European Journal of Cardio-Thoracic Surgery321010-7940doi: DOI: 10.1016/j.ejcts.2007.06.012http://www.sciencedirect.com/science/article/B6T35-4P77G8P-2/2/005fdd499a1e5994cf54955706b41dfcEuropean Journal of Cardio-Thoracic Surgery1(202), and this was supported by the present results. CPB is an intra-operative variable and may be a dominant predictor influencing the ability of multivariate test models to assess the impact of PPM. However, following the exclusion of CPB, PPM was still not found to be a significant predictor of survival. Mohty et al.  ADDIN REFMGR.CITE Mohty20092Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionJournal2Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement: Influence of Age, Obesity, and Left Ventricular DysfunctionMohty,DaniaDumesnil,Jean G.Echahidi,NajmeddineMathieu,PatrickDagenais,FrantoisVoisine,PierrePibarot,Philippe2009aortic valveheart valve prostheseshemodynamicsmortalityNot in File3947Journal of the American College of Cardiology530735-1097doi: DOI: 10.1016/j.jacc.2008.09.022http://www.sciencedirect.com/science/article/B6T18-4V8B39S-9/2/f7a66045e843a4c5dccfd4d747db2040Journal of the American College of Cardiology1(49) reported that severe PPM following surgery for aortic stenosis had a negative effect on late survival in patients younger than 70 years, but not in the elderly population. These results are consistent with those of Moon et al.  ADDIN REFMGR.CITE Moon2006331Prosthesis-Patient Mismatch After Aortic Valve Replacement: Impact of Age and Body Size on Late SurvivalJournal331Prosthesis-Patient Mismatch After Aortic Valve Replacement: Impact of Age and Body Size on Late SurvivalMoon,Marc R.Pasque,Michael K.Munfakh,Nabil A.Melby,Spencer J.Lawton,Jennifer S.Moazami,NaderCodd,John E.Crabtree,Traves D.Barner,Hendrick B.Damiano,Ralph J.,Jr.2006Aortic ValveAortic valve replacementBody SizeBody Surface AreamethodsNot in File481489Ann Thorac Surg81http://ats.ctsnetjournals.org/cgi/content/abstract/81/2/481The Annals of Thoracic SurgeryAnn Thorac Surg1(48), suggesting that the impact of PPM on postoperative outcome is more pronounced in young patients than in older ones. Younger patients have higher cardiac output requirements and are generally more physically active and, due to their longer life expectancy, they are exposed to the risk of PPM for a longer period of time. In several studies, including that presented on Paper IV, the mean age of the patients with aortic insufficiency was lower than that for patients with aortic stenosis  ADDIN REFMGR.CITE Tornos20068Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgeryJournal8Long-term outcome of surgically treated aortic regurgitation: influence of guideline adherence toward early surgeryTornos,P.Sambola,A.Permanyer-Miralda,G.Evangelista,A.Gomez,Z.Soler-Soler,J.2006AdolescentAdultAgedaortic valveAortic Valve InsufficiencyChronic DiseaseFemaleFollow-Up StudiesGuideline AdherenceHumansMalemethodsMiddle AgedProspective StudiesSeverity of Illness IndexsurgeryTime FactorsTreatment OutcomeNot in File10121017J Am Coll Cardiol47
Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. ptornos@vhebron.net
PM:16516086J Am Coll Cardiol1Rothenburger200327Aortic valve replacement for aortic regurgitation and stenosis, in patients with severe left ventricular dysfunctionJournal27Aortic valve replacement for aortic regurgitation and stenosis, in patients with severe left ventricular dysfunctionRothenburger,M.Drebber,K.Tjan,T.D.Schmidt,C.Schmid,C.Wichter,T.Scheld,H.H.Deiwick,M.2003Aortic ValveAortic Valve InsufficiencyAortic Valve StenosiscomplicationsCoronary Artery BypassEchocardiographyEchocardiography,DopplerFemaleFollow-Up StudiesGermanyHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityOdds RatioRetrospective StudiessurgerySurvival AnalysisSurvival RateTreatment OutcomeVentricular Dysfunction,LeftNot in File703709Eur J Cardiothorac.Surg23
Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany. markus.rothenburger@thgms.uni-muenster.de
PM:12754021Eur J Cardiothorac.Surg1(201;203). Therefore, patients with aortic insufficiency would theoretically constitute a suitable population for evaluating the impact of PPM on survival. However, in our study, patients with PPM did not show impaired survival compared to non-PPM patients when adjusted for potential confounding variables. 5.8 General discussion How can the results of the present work be explained when logic suggests that sustained elevated transprosthetic energy loss should translate into impaired LV remodeling and decreased long-term survival? The answer is not straightforward, but the following hypotheses may offer some explanation. The natural history of mild, native aortic valve stenosis is unknown. At least moderate PPM mimics the hemodynamic properties of mild native aortic stenosis. Furthermore, progressive aortic disease tends to become apparent in elderly persons, a patient category where mild non-progressive stenosis may be well tolerated due to less cardiac output demanding physical activity  ADDIN REFMGR.CITE Blackstone200376Prosthesis size and long-term survival after aortic valve replacementJournal76Prosthesis size and long-term survival after aortic valve replacementBlackstone,E.H.Cosgrove,D.M.Jamieson,W.R.Birkmeyer,N.J.Lemmer,J.H.,Jr.Miller,D.C.Butchart,E.G.Rizzoli,G.Yacoub,M.Chai,A.2003AgedAlgorithmsAortic ValveBioprosthesisBody Surface AreaFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityProsthesis Designstatistics & numerical datasurgerySurvival RateTime FactorsNot in File783796J.Thorac.Cardiovasc.Surg.126
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA. blackse@ccf.org
PM:14502155J.Thorac.Cardiovasc.Surg.1(43). Patients who undergo AVR have slightly lower long-term survival than an age-, sex-, and race-matched controls  ADDIN REFMGR.CITE van Geldorp200992Therapeutic decisions for patients with symptomatic severe aortic stenosis: room for improvement?Journal92Therapeutic decisions for patients with symptomatic severe aortic stenosis: room for improvement?van Geldorp,M.W.A.van Gameren,M.Kappetein,A.P.Arabkhani,B.de Groot-de Laat,L.E.Takkenberg,J.J.M.Bogers,A.J.J.C.2009Aortic ValveHeartMalemethodsmortalityRisksurgeryNot in File953957European Journal of Cardio-Thoracic Surgery3510107940European Journal of Cardio-Thoracic Surgery1Carabello200489Is it ever too late to operate on the patient with valvular heart disease?Journal89Is it ever too late to operate on the patient with valvular heart disease?Carabello,Blase A.2004HeartNot in File376383Journal of the American College of Cardiology440735-1097doi: DOI: 10.1016/j.jacc.2004.03.061http://www.sciencedirect.com/science/article/B6T18-4CW4HG2-11/2/bba1ecb8372f4120cc8b50b2cb603965Journal of the American College of Cardiology1Blackstone200376Prosthesis size and long-term survival after aortic valve replacementJournal76Prosthesis size and long-term survival after aortic valve replacementBlackstone,E.H.Cosgrove,D.M.Jamieson,W.R.Birkmeyer,N.J.Lemmer,J.H.,Jr.Miller,D.C.Butchart,E.G.Rizzoli,G.Yacoub,M.Chai,A.2003AgedAlgorithmsAortic ValveBioprosthesisBody Surface AreaFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalityProsthesis Designstatistics & numerical datasurgerySurvival RateTime FactorsNot in File783796J.Thorac.Cardiovasc.Surg.126
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F25, Cleveland, OH 44195, USA. blackse@ccf.org
PM:14502155J.Thorac.Cardiovasc.Surg.1(43;176;204). Mortality is affected by complications resulting from warfarin anticoagulation treatment, particularly its variability  ADDIN REFMGR.CITE Butchart200269Better anticoagulation control improves survival after valve replacementJournal69Better anticoagulation control improves survival after valve replacementButchart,E.G.Payne,N.Li,H.H.Buchan,K.Mandana,K.Grunkemeier,G.L.2002AdolescentAdultAgedAged,80 and overaortic valveAortic valve replacementbloodBlood CoagulationCoronary Artery BypassepidemiologyetiologyFemaleFollow-Up StudiesGreat BritainHeart Valve DiseasesHeart Valve Prosthesis ImplantationHumansIncidenceInternational Normalized RatioMalemethodsMiddle AgedMitral ValvemortalityMultivariate AnalysisObserver VariationphysiologyPostoperative ComplicationsPredictive Value of TestsProspective StudiesRisk FactorsStrokesurgerySurvival AnalysisThromboembolismTime FactorsTreatment OutcomeNot in File715723J Thorac Cardiovasc Surg123
Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, United Kingdom. egbutchart@aol.com
PM:11986600J Thorac Cardiovasc Surg1(205), among patients with mechanical devices, and by re-operation for SVD among those with biological prostheses. Paper IV reports a difference in survival according to type of prosthesis. The implantation of a bioprosthesis was an independent predictor of increased late mortality (HR 4.1; 95% CI 1.8-9.7). Type of prostheses was, however, not found to be a significant predictor of impaired survival in our earlier studies (Paper I & III), which is consistent with previously published findings  ADDIN REFMGR.CITE McGiffin199393An analysis of risk factors for death and mode-specific death after aortic valve replacement with allograft, xenograft, and mechanical valvesJournal93An analysis of risk factors for death and mode-specific death after aortic valve replacement with allograft, xenograft, and mechanical valvesMcGiffin,D.C.O'Brien,M.F.Galbraith,A.J.McLachlan,G.J.Stafford,E.G.Gardner,M.A.Pohlner,P.G.Early,L.Kear,L.1993Actuarial AnalysisAortic ValveAustraliaBioprosthesisDeath,SuddenDeath,Sudden,CardiacEndocarditisepidemiologyEquipment DesignFemaleHeart Valve DiseasesHeart Valve ProsthesisHumansMaleMiddle AgedmortalityMultivariate AnalysisProportional Hazards ModelsRetrospective StudiesRiskRisk FactorssurgerySurvival AnalysisNot in File895911J Thorac Cardiovasc Surg106
Department of Cardiac Surgery, Prince Charles Hospital, Brisbane, Queensland, Australia
PM:8231214J Thorac Cardiovasc Surg1(206). Once again, the multifactorial nature of reduced survival after AVR may mask subtle individual components of its leading causes, such as the implantation of a small prosthesis in relation to patient size, or the type of prosthesis chosen. Degenerative aortic valve stenosis is a disease of elderly patients with already limited life spans. Although we tested for interactions between age and PPM (Paper IV) we found none: Elderly patients may simply not live long enough to manifest impaired survival related to PPM. The incidence of severe PPM (0.65 cm2/m2) is low in many reports  ADDIN REFMGR.CITE Howell2006329Patient-prosthesis mismatch does not affect survival following aortic valve replacementJournal329Patient-prosthesis mismatch does not affect survival following aortic valve replacementHowell,N.J.Keogh,B.E.Barnet,V.Bonser,R.S.Graham,T.R.Rooney,S.J.Wilson,I.C.Pagano,D.2006Adultadverse effectsAgedAged,80 and overAortic ValveAortic valve replacementBody Surface AreaEpidemiologic MethodsFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedmortalitypathologyProsthesis DesignProsthesis FittingsurgeryTreatment OutcomeNot in File1014Eur.J Cardiothorac.Surg30
Department of Cardiothoracic Surgery, University Hospital NHS Foundation Trust, Birmingham, UK
PM:16723251Eur.J Cardiothorac.Surg1Walther2006333Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacementJournal333Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacementWalther,ThomasRastan,ArdawanFalk,VolkmarLehmann,SvenGarbade,JensFunkat,Anne K.Mohr,Friedrich W.Gummert,Jan F.2006Aortic ValveAortic valve replacementBody Surface AreamethodsmortalityRegression AnalysisRisk FactorssurgerySurvival AnalysisNot in File1519European Journal of Cardio-Thoracic Surgery30http://ejcts.ctsnetjournals.org/cgi/content/abstract/30/1/15European Journal of Cardio-Thoracic Surgery1(64;65), although this was not supported by the results presented in Paper III. In order to unanimously find a significant impact on clinical outcome, perhaps the threshold for severe PPM should be lowered to 0.45-0.50 cm2/m2 corresponding to severe native aortic valve stenosis  ADDIN REFMGR.CITE Bonow199879Guidelines for the Management of Patients With Valvular Heart Disease : Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)Journal79Guidelines for the Management of Patients With Valvular Heart Disease : Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)Bonow,Robert O.Carabello,Blasede Leon,Antonio C.,Jr.Edmunds,L.Henry,Jr.Fedderly,Bradley J.Freed,Michael D.Gaasch,William H.McKay,Charles R.Nishimura,Rick A.O'Gara,Patrick T.O'Rourke,Robert A.Rahimtoola,Shahbudin H.Ritchie,James L.Cheitlin,Melvin D.Eagle,Kim A.Gardner,Timothy J.Garson,Arthur,Jr.Gibbons,Raymond J.Russell,Richard O.Ryan,Thomas J.Smith,Sidney C.,Jr.1998HeartNot in File19491984Circulation98http://circ.ahajournals.orgCirculation1(207). This strategy would, for natural reasons, limit the number patients available for analysis, as almost no prostheses would reach this level of PPM unless SVD occurs postoperatively. The relatively small increase in early mortality previously found among patients with PPM  ADDIN REFMGR.CITE Blais20033Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementJournal3Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacementBlais,C.Dumesnil,J.G.Baillot,R.Simard,S.Doyle,D.Pibarot,P.2003adverse effectsAgedAortic ValveBody SizeCohort StudiesepidemiologyFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansIntraoperative PeriodMalemortalityMultivariate AnalysisOdds RatioOutcome Assessment (Health Care)physiopathologyPostoperative PeriodProspective StudiesQuebecReference ValuesResearch Support,Non-U.S.Gov'tRisk AssessmentRisk Factorsstandardsstatistics & numerical dataStroke VolumesurgeryTimeVascular PatencyNot in File983988Circulation108
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada
PM:12912812Circulation1(12) may serve as a biological selection process. However, Blackstone and colleagues evaluated 1109 patients with small prostheses (with a labeled size of 19 mm or smaller) and reported that early mortality was sufficiently low, and survival sufficiently long to suggest that this is not an important explanation. The way in which manufacturers label valves sizes varies and may lead to inappropriate hemodynamic comparisons between valves with the same nominal size  ADDIN REFMGR.CITE Christakis199846Inaccurate and misleading valve sizing: a proposed standard for valve size nomenclatureJournal46Inaccurate and misleading valve sizing: a proposed standard for valve size nomenclatureChristakis,G.T.Buth,K.J.Goldman,B.S.Fremes,S.E.Rao,V.Cohen,G.Borger,M.A.Weisel,R.D.1998Aortic ValveAortic Valve InsufficiencyAortic Valve StenosisBioprosthesisHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamicsHumansmethodsProsthesis DesignProsthesis FittingstandardssurgeryTerminology as TopicNot in File11981203Ann.Thorac Surg66
Division of Cardiovascular Surgery, Sunnybrook Health Science Centre and the Toronto Hospital, University of Toronto, Ontario, Canada
PM:9800806Ann.Thorac Surg1(152). Prosthesis size may be based on physical dimensions or functional performance. Physical dimensions include labeled size and internal orifice size. Since manufacturers conventions for labeling prosthesis size differ among devices, some authors have chosen the geometric internal orifice diameter to characterize PPM because the internal geometric area is suggested to be more reproducible  ADDIN REFMGR.CITE Christakis199846Inaccurate and misleading valve sizing: a proposed standard for valve size nomenclatureJournal46Inaccurate and misleading valve sizing: a proposed standard for valve size nomenclatureChristakis,G.T.Buth,K.J.Goldman,B.S.Fremes,S.E.Rao,V.Cohen,G.Borger,M.A.Weisel,R.D.1998Aortic ValveAortic Valve InsufficiencyAortic Valve StenosisBioprosthesisHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamicsHumansmethodsProsthesis DesignProsthesis FittingstandardssurgeryTerminology as TopicNot in File11981203Ann.Thorac Surg66
Division of Cardiovascular Surgery, Sunnybrook Health Science Centre and the Toronto Hospital, University of Toronto, Ontario, Canada
PM:9800806Ann.Thorac Surg1(152). Functional size includes in vitro and in vivo effective orifice areas. The former may be static at a variety of steady flow rates or dynamic with a variety of pulsatile waveforms and flow rates  ADDIN REFMGR.CITE Blais200135Comparison of valve resistance with effective orifice area regarding flow dependenceJournal35Comparison of valve resistance with effective orifice area regarding flow dependenceBlais,C.Pibarot,P.Dumesnil,J.G.Garcia,D.Chen,D.Durand,L.G.2001AdultAgedAnalysis of VarianceAortic ValveAortic Valve StenosisBlood Flow VelocityEchocardiography,DopplerExerciseFemaleHeartHeart Valve ProsthesisHumansMaleMiddle AgedModels,CardiovascularModels,StructuralphysiologyphysiopathologyPulsatile FlowStroke VolumesurgeryultrasonographyVascular ResistanceNot in File4552Am.J Cardiol.88
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada
PM:11423057Am.J Cardiol.1(208); the latter is estimated clinically under a range of incompletely controlled conditions in patients by echocardiography according to various formulas. In vivo EOA varies from moment to moment with patient activity  ADDIN REFMGR.CITE Dumesnil19907Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyJournal7Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyDumesnil,J.G.Honos,G.N.Lemieux,M.Beauchemin,J.1990AgedAortic ValveAortic Valve StenosisBioprosthesisBody Surface AreadiagnosisEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHumansMaleMitral ValvePostoperative PeriodProsthesis DesignsurgeryNot in File637643J Am.Coll.Cardiol.16
Quebec Heart Institute, Laval University, Sainte-Foy, Canada
PM:2387937J Am.Coll.Cardiol.1(5), cardiac output and blood pressure, and dynamics of the LV tract, as well as intrinsic prosthesis properties, although it is strongly correlated with the geometric internal orifice area.  ADDIN REFMGR.CITE Dumesnil19907Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyJournal7Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyDumesnil,J.G.Honos,G.N.Lemieux,M.Beauchemin,J.1990AgedAortic ValveAortic Valve StenosisBioprosthesisBody Surface AreadiagnosisEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHumansMaleMitral ValvePostoperative PeriodProsthesis DesignsurgeryNot in File637643J Am.Coll.Cardiol.16
Quebec Heart Institute, Laval University, Sainte-Foy, Canada
PM:2387937J Am.Coll.Cardiol.1(5). However, in vivo EOA is unavailable at the time of selecting prosthesis for AVR. Pibarot and colleagues  ADDIN REFMGR.CITE Pibarot200144Patient-prosthesis mismatch can be predicted at the time of operationJournal44Patient-prosthesis mismatch can be predicted at the time of operationPibarot,P.Dumesnil,J.G.Cartier,P.C.Metras,J.Lemieux,M.D.2001AdultAortic ValveBioprosthesisEchocardiography,DopplerExerciseFemaleHeart Valve DiseasesHeart Valve ProsthesisHemodynamic ProcessesHumansMaleMiddle AgedPatient SelectionphysiologyPostoperative ComplicationsPredictive Value of Testsprevention & controlProsthesis DesignProsthesis FittingPulmonary ValveResearch Support,Non-U.S.Gov'tStentssurgerytransplantationTransplantation,AutologousTransplantation,HomologousultrasonographyNot in FileS265S268Ann.Thorac.Surg.71
Quebec Heart Institute, Laval Hospital, Laval University, Sainte-Foy, Canada. philippe.pibarot@med.ulaval.ca
PM:11388201Ann.Thorac.Surg.1(209) and Dumesnil and coworkers  ADDIN REFMGR.CITE Dumesnil19907Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyJournal7Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiographyDumesnil,J.G.Honos,G.N.Lemieux,M.Beauchemin,J.1990AgedAortic ValveAortic Valve StenosisBioprosthesisBody Surface AreadiagnosisEchocardiography,DopplerFemaleFollow-Up StudiesHeart Valve ProsthesisHumansMaleMitral ValvePostoperative PeriodProsthesis DesignsurgeryNot in File637643J Am.Coll.Cardiol.16
Quebec Heart Institute, Laval University, Sainte-Foy, Canada
PM:2387937J Am.Coll.Cardiol.1(5) have suggested that rather than using geometric prosthesis dimensions as a reference for prosthesis size, a reference value of in vivo EOA should be used, termed the projected EOA. However, this strategy has several drawbacks. It suffers from flow dependency, a large scatter in the data, rest versus exercise differences, and limited availability of data for each prosthesis size and model. Identifying a high transvalvular pressure gradient in a patient with a prosthetic valve is often a difficult diagnostic challenge and may not always indicate a prosthesis-patient mismatch. High transprosthetic pressure gradients may be present after AVR due to intrinsic stenosis or a state of high cardiac output. The most logical approach to assessing intrinsic prosthesis performance is to compare the EOA measured by Doppler echocardiography to the reference values measured either in vitro or in vivo for the same model and size of prosthesis. A value substantially lower than the reference values may suggest an intrinsic stenotic process (e.g., tissue ingrowth, thrombus, calcification), and even more so if there had been a progressive reduction in the EOA over time  ADDIN REFMGR.CITE Pibarot200050Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionJournal50Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its preventionPibarot,P.Dumesnil,J.G.2000Aortic ValveAortic Valve StenosisEchocardiography,Doppler,ColorHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHemodynamic ProcessesHumansinstrumentationmortalityphysiologyphysiopathologyProsthesis FailureProsthesis FittingReoperationResearch Support,Non-U.S.Gov'tsurgerySurvival RateultrasonographyNot in File11311141J.Am.Coll.Cardiol.36
Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Canada
PM:11028462J.Am.Coll.Cardiol.1(9). If the finding of a high transvalvular gradient is mainly due to PPM, as indicated by an EOA consistent with normal reference values but an indexed EOA d"0.85 cm2/m2, there are no precise management guidelines at present. If the patient develops the usual symptoms associated with aortic stenosis and has an indexed EOA compatible with severe stenosis (EOAi d"0.60 cm2/m2), re-operation should be considered, as is the case for native valves  ADDIN REFMGR.CITE Bonow199879Guidelines for the Management of Patients With Valvular Heart Disease : Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)Journal79Guidelines for the Management of Patients With Valvular Heart Disease : Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)Bonow,Robert O.Carabello,Blasede Leon,Antonio C.,Jr.Edmunds,L.Henry,Jr.Fedderly,Bradley J.Freed,Michael D.Gaasch,William H.McKay,Charles R.Nishimura,Rick A.O'Gara,Patrick T.O'Rourke,Robert A.Rahimtoola,Shahbudin H.Ritchie,James L.Cheitlin,Melvin D.Eagle,Kim A.Gardner,Timothy J.Garson,Arthur,Jr.Gibbons,Raymond J.Russell,Richard O.Ryan,Thomas J.Smith,Sidney C.,Jr.1998HeartNot in File19491984Circulation98http://circ.ahajournals.orgCirculation1(207). However, according to Hanayama et al. ADDIN REFMGR.CITE Hanayama200214Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantJournal14Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevantHanayama,N.Christakis,G.T.Mallidi,H.R.Joyner,C.D.Fremes,S.E.Morgan,C.D.Mitoff,P.R.Goldman,B.S.2002AdultAgedAnthropometryAortic ValveepidemiologyetiologyFemaleFollow-Up StudiesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMalemethodsMiddle AgedPostoperative ComplicationsPrevalenceProspective StudiesProsthesis Designstatistics & numerical datasurgerySurvival RateNot in File18221829Ann.Thorac.Surg.73
Division of Cardiovascular Surgery of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
PM:12078776file://H:\Dokument\Publications on PPM\HanayamaPPM is rare after AVR.pdfAnn.Thorac.Surg.1(45), one should not use one set of assumptions and logic for PPM and a completely different set for treating patients with native aortic valve disease. It is rare to operate on patients with moderate gradients (mean TPG 20-35 mmHg) and no symptoms (except for other concomitant cardiac surgery) as long-term survival is not improved in these patients. If there were clear scientific evidence that PPM with mild to moderate gradients and EOAi <0.85 cm2/m2 decreased long-term survival, all patients with mild to moderate aortic stenosis would have been referred for redo AVR. Similarly, evidence from exercise gradients is often used to support the PPM theory. The commonly adopted theory is that patients with mild to moderate gradients at rest have much higher gradients during exercise. If one were to use consistent logic, the inference from this theory would be that we should exercise all patients with mild to moderate native aortic stenosis, and operate on patients with high exercise gradients to improve long-term survival. This regimen is currently not applied due to lack of supportive evidence  ADDIN REFMGR.CITE Bonow200611ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsJournal11ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic SurgeonsBonow,R.O.Carabello,B.A.Chatterjee,K.de,Leon AC,Jr.Faxon,D.P.Freed,M.D.Gaasch,W.H.Lytle,B.W.Nishimura,R.A.O'Gara,P.T.O'Rourke,R.A.Otto,C.M.Shah,P.M.Shanewise,J.S.Smith,S.C.,Jr.Jacobs,A.K.Adams,C.D.Anderson,J.L.Antman,E.M.Fuster,V.Halperin,J.L.Hiratzka,L.F.Hunt,S.A.Lytle,B.W.Nishimura,R.Page,R.L.Riegel,B.2006diagnosisHeart Valve DiseasesHumanstherapyNot in Filee1148J Am Coll Cardiol48PM:16875962J Am Coll Cardiol1(63). Finally, it was mainly the use of small-sized aortic valve prostheses in the era of caged-ball prostheses that had raised concerns about the presence of significant residual gradients, with the potential detrimental sequelae in the left ventricle  ADDIN REFMGR.CITE Rahimtoola1978306The problem of valve prosthesis-patient mismatchJournal306The problem of valve prosthesis-patient mismatchRahimtoola,S.H.1978adverse effectsanatomy & histologyConstriction,PathologicetiologyHeart Valve DiseasesHeart Valve ProsthesisHeart ValvesHemodynamic ProcessesHumanspathologyphysiopathologyNot in File2024Circulation58PM:348341Circulation1(1). Thus, the concept of PPM was based on reports evaluating first -generation biological and mechanical prostheses. 5.9 Limitations The patients in these studies were those treated at a single department and may not be representative of those at other centers. None of the studies was randomized but instead retrospective, introducing the possibility that selection bias might cause differences in patient groups, which might influence survival but are not accounted for, even with the extensive multivariable analyses conducted. Furthermore, all outcomes were not investigated, and PPM might have an impact on functional recovery, heart failure symptoms, rehospitalization, and impaired quality of life. Survival is not the only outcome of AVR, although it is the most important. The Kaplan-Meier and Cox proportional hazard methods require the implicit assumption that censoring is independent of clinical outcome, which cannot be verified. It is possible that patients lost to follow-up may have had outcomes that were important but not accounted for in the analyses or that resulted in their being lost to follow-up. Survival data obtained from studies with large patient numbers decrease the risk of type II errors. On the other hand, great difficulties arise when one has to examine indices of LV hemodynamics and function over time for a large number of patients over a long period of time. There are situations in which the use of complex forms of aortic valve replacement, such as aortic valve homografts, pulmonary valve autotransplantation, aortic root enlargement procedures, and stentless xenograft valves, are indicated. Single-center studies are limited particularly regarding the number of patients receiving small prostheses, and multi-center studies are therefore required. Finally, low operative mortality necessitates a large study with a sufficient number of deaths to achieve adequate statistical power. Future perspectives For symptomatic patients with severe aortic valve stenosis, open-heart surgery with aortic valve replacement using cardioplegia under cardiopulmonary bypass remains the gold standard. Cumulative surgical experience and technical improvement over more than five decades have led to excellent perioperative results with low mortality and morbidity. Long-term results are convincing as long-term survival is close to that in the average population, and the durability of biological prostheses is favorable in the elderly. Even in octogenarians, aortic valve replacement is feasible with acceptable results. The importance of patient-prosthesis mismatch has been the subject of a substantial number of publications during the past decade. However, the majority of these studies are small and retrospective including different definitions of mismatch as well as heterogeneous populations. In the authors opinion, there is no convincing evidence that patient-prosthesis mismatch should be considered a matter of priority when performing aortic valve replacement. Despite excellent peri- and postoperative clinical results a large randomized trial is warranted to gain insight and deeper knowledge in this matter. As this is not possible, due to ethical reasons, the following strategies may assist in elucidating the concept of patient-prosthesis mismatch: To facilitate comparisons of hemodynamic measurements and clinical endpoints standardized criteria and definitions of the term prosthesis-patient mismatch is required. A potentially interesting design would be to normalize the EOA to the fat-free mass, since this parameter appears to be the main determinant of cardiac output in normal-weight, overweight, and obese people (previously elaborated in Introduction). A multi-institutional study would allow a gathering of a substantial number of patients with maximized homogeneity of baseline characteristics and with a sufficient number of deaths to achieve adequate statistical power. Conclusions Based on the findings of the studies presented in this thesis the following major conclusions can be drawn: Paper I Prosthesis-patient mismatch is an independent risk factor for postoperative neurological events following aortic valve replacement. However, this probably reflects a more complex surgical procedure in a small aortic root with extensive calcification. Prosthesis-patient mismatch was present in nearly half of the patients undergoing aortic valve replacement, although severe PPM was rare, but no impact ws found on early or late survival. Postoperative high transprosthetic gradients were not correlated with low cardiac output syndrome. Paper II Postoperative heart failure following aortic valve replacement was associated with high early mortality. A postoperatively elevated BNP level was a predictor of heart failure after aortic valve replacement, although its discriminatory ability was relatively poor. Paper III Prosthesis-patient mismatch did not impair the recovery of diastolic function or left ventricular mass regression. Prosthesis-patient mismatch was not a predictor of poor survival following implantation of the Sorin Soprano or the Medtronic Mosaic bioprostheses during aortic valve replacement. Paper IV The presence of prosthesis-patient mismatch did not influence postoperative LV remodeling in terms of regression of the LV dimensions. There was no difference in postoperative recovery of LV systolic function in patients with and without prosthesis-patient mismatch, and the LV remodeling process was initiated regardless of preoperative LVEF. Prosthesis-patient mismatch was common in patients with severe aortic insufficiency undergoing aortic valve replacement, although severe prosthesis-patient mismatch was rare. Prosthesis-patient mismatch was not a predictor of increased early or late mortality following aortic valve replacement for severe aortic insufficiency. Populrvetenskaplig sammanfattning (Summary in Swedish) Aortastenos, dvs. en frtrngning och frkalkning av hjrtats aortaklaff (vnsterkammarens utfldesklaff), r nst efter kranskrlssjukdom den vanligaste orsaken till att patienter genomgr hjrtkirurgi i den industrialiserade delen av vrlden. Kombinationen av en ldrande befolkning i vstvrlden och en frbttrad hjrtdiagnostik har lett till en kontinuerlig kning av antalet patienter som remitteras fr aortaklaffkirurgi. Vid operation fr aortastenos avlgsnas den frkalkade klaffen och erstts med en konstgjord klaffprotes. Operation fr aortainsufficiens (lckage i aortaklaffen) r mindre vanligt. Nr aortaklaffen inte r frkalkad, kan den hos vissa patienter repareras, men den vanligaste tgrden r fortfarande att byta den sjuka klaffen mot en klaffprotes. I stora drag kan man dela upp moderna klaffproteser i tv grupper: mekaniska och biologiska. Mekaniska klaffproteser r vanligen tillverkade av olika kolfibermaterial. Frdelen med denna typ av klaffprotes r att den har en vsentligen obegrnsad livslngd, men nackdelen r att den krver livslng antikoagulationsbehandling (behandling som motverkar blodproppar). Biologiska klaffproteser r vanligen tillverkade av aortaklaffar tagna frn grisar, alternativt r klaffbladen tillverkade av perikard (hjrtsck) frn kalv. Frdelen med biologiska klaffproteser r att de inte behver antikoagulationsbehandling, men nackdelen r att bioproteserna har en begrnsad hllbarhet. Valet av klaffprotes har varit freml fr en omfattande debatt de senaste decennierna. Utvecklingen av klaffproteser har successivt frbttrat protesernas hemodynamiska egenskaper, men grundkonstruktion r dock av sdan art att en frtrngning ver protesen alltid kvarstr jmfrt med en normal aortaklaff. Det r dock otvetydigt s att en hjrtoperation med insttandet av en klaffprotes i aortaposition, oavsett etiologi, frbttrar patientens verlevnad, symptom och hemodynamik. Efter operationen genomgr hjrtat en ombyggnadsprocess som leder till att vnsterkammarens pumpfunktion frbttras och hjrtmuskelfrtjockningen successivt gr tillbaka. Det r dock nnu oklart vilken betydelse implantation av en liten klaffprotes med liten ppningsarea (EOA; effective orifice area) har fr samma utfallsvariabler. Under sin operation fr patienten en klaffprotes som storleksanpassas efter aortaannulus oftast 21-27 mm. En klaffoperation p sm patienter kan bli mycket komplicerad pga. en trng aortaannulus med uttalad frkalkning varfr dessa patienter oftare fr en relativt liten klaffprotes inopererad. Sm klaffproteser har en mindre EOA, vilket leder till hgre transvalvulra gradienter. Eftersom mnniskor med strre kroppsyta har en strre hjrt-minutvolym s har de ocks teoretiskt sett behov av en strre klaffprotes med strre EOA. Fr att f ett jmfrbart mtt p patienternas, teoretiskt sett, minsta acceptabla klaffprotesstorlek har man i tidigare studier indexerat EOA mot kroppsyta och benmnt detta indexerad klaffarea (EOAi). Baserat p experimentella fldesmodeller har man tidigare pvisat en exponentiell relation mellan EOAi och transvalvulra gradienter och ur detta samband har man sedan hrlett trskelvrden vid vilka negativa kliniska konsekvenser skulle kunna uppst. Denna teori r tidigare beskriven i litteraturen som prosthesis-patient mismatch (PPM). Frklaringen till eventuella negativa kliniska konsekvenser av PPM r fljande: en kvarstende utfldesobstruktion, dvs. frhjd afterload, vilket tvingar vnsterkammaren att arbeta hrdare med kat syrgasbehov till fljd. Detta merarbete leder till en kvarvarande frtjockning av vnsterkammarmuskeln, som i kombination med det kade arbetet, fresls leda till en frsmrad verlevnad och minskande arbetskapacitet. Det finns fler kirurgiska tgrder som man kan ta till fr att undvika PPM i samband med aortaklaffkirurgi, men de har alla ett gemensamt och det r att de kar operationens komplexitet. En kad kirurgisk svrighetsgrad leder generellt till kad mortalitet och morbiditet varfr det r viktigt att utrna huruvida PPM har ngra kliniska konsekvenser av dignitet. Trots att en klaff med liten EOA teoretiskt skulle kunna hindra en effektiv postoperativ ombyggnadsprocess och drmed intuitivt borde leda till frsmrade resultat s rder det i dagslget ingen konsensus med avseende p kirurgisk handlggning. Evidensgraden r lg och tidigare publikationer visar p lngt ifrn entydiga resultat. Detta kan delvis frklaras av att mnga studier r sm och heterogena med avseende p studiepopulation, men ocks pga. Att man anvnt mnga olika definitioner fr PPM. Detta har sammantaget lett till att man med skerhet varken kunnat pvisa eller avskriva en klinisk relevans fr PPM. Avhandlingen syftar till att studera prosthesis-patient mismatch och dess kliniska betydelse ur nya infallsvinklar. I de arbeten som presenteras evalueras PPM och dess relevans fr postoperativ morbiditet, vnsterkammarens terhmtningsfrmga avseende systolisk- och diastolisk funktion samt regressionsgraden av vnsterkammarhypertrofi. Vidare undersks incidensen av postoperativ hjrtsvikt efter aortaklaffkirurgi och en specifik hjrtsviktsmarkr (BNP; brain natriuretic peptide) utvrderas kliniskt. Patienter som genomgr aortaklaffoperation p basen av aortainsufficiens har ofta en annulr dilatation och frnvaro av kalcifiering i aortaroten tv faktorer som borde motverka uppkomsten av PPM. Om prosthesis-patient mismatch frekommer hos denna patientkategori s freligger en hypotetisk in vivo modell som kan anvndas fr att studera effekten av PPM p vnsterkammarens terhmtningsfrmga med avseende p dimensioner och funktion. Resultaten frn denna avhandling talar fr att PPM leder ej till frsmrad verlevnad p kort eller lng sikt. Dock lpte patienter med prosthesis-patient mismatch en strre risk att drabbas av neurologisk pverkan, inklusive stroke (slaganfall), i det postoperativa frloppet. Detta fynd frklaras sannolikt av att patienter med prosthesis-patient mismatch oftare har en trng aortarot med uttalad frkalkning vilket leder till att det kirurgiska ingreppet kar i komplexitet med kar risken fr stroke som fljd. Frekomsten av prosthesis-patient mismatch samvarierar sannolikt med dessa faktorer s att ven avancerade statistiska metoder kan ha svrt att justera fr effekter av kovariater. Vra resultat visar ocks att PPM ej pverkar den postoperativa terhmtningen av vnsterkammarens systoliska eller diastoliska funktion. Vra fynd talar ocks fr att vnsterkammarhypertrofi och vnsterkammarmassa gick i regress oavsett frekomst av PPM eller ej. Vidare kunde vi visa att postoperativ hjrtsvikt efter aortaklaffkirurgi predikterar smre verlevnad, men ingen association mellan PPM och postoperativ hjrtsvikt kunde pvisas. Dessutom kunde vi visa att vnsterkammarens dimensioner och systoliska funktion terhmtar sig oavsett frekomst av PPM hos patienter som genomgr aortaklaffkirurgi pga. aortainsufficiens. I denna avhandling studeras effekten av PPM p selekterade utfallsvariabler, dvs. verlevnad, komplikationer efter kirurgi samt hjrtats funktion, storlek och tjocklek. Huruvida PPM kan ha en klinisk relevans avseende fysisk anstrngningsfrmga har dock ej studerats. Sammanfattningsvis frefaller prosthesis-patient mismatch som variabel ej utgra en riskfaktor fr frsmrad verlevnad eller kardiella postoperativa komplikationer. Frekomsten av PPM verkar ej heller utgra ett hinder fr vnsterkammarens postoperativa remodellering med avseende p massa, funktion och dimensioner. Vr sammanvgda slutsats fr denna avhandling r att PPM inte verkar ha ngon strre klinisk relevans och drfr br man enligt vr mening undvika att komplicera det kirurgiska ingreppet i syfte att implantera en hemodynamiskt verlgsen klaffprotes. Vr sikt r att man istllet br man premiera en fr kirurgen lttanvnd klaffprotes, som i kombination med ett standardiserat tillvgagngsstt, leder till kortast mjliga operationstid med bibehllen skerhet. Acknowledgements Welcome to the certainly most-read and probably most enjoyable part of this thesis. Although the appearance of one authors name on the cover may suggest that this is the product of a single individual, the help of many others has been more than essential. The faults of this thesis are all mine, but a number of people guided and supported me and made this work possible. Sometimes I was ungrateful, and occasionally regretted having to disregard their advice, but I still owe my heartfelt gratitude to: Associate Professor Johan Sjgren, my friend, supervisor and mentor, whom I admire both professionally and personally. Your vast knowledge, unstoppable enthusiasm and working spirit has guided and assisted me to scientific maturity. Your love of cardiothoracic surgery has inspired me to pursue perfection in my clinical skills. Together, we have trodden the numerous paths of research, sometimes ending up in dead-end, sometimes in dark alleys. No matter where we ended up, you managed to lead us through and to eventually find our way, driven by a never-ending source of positivism and passion for learning. Thank you for believing in me, praising my merits and overlooking my shortcomings. Johan Nilsson, MD, PhD, my co-supervisor and friend, for sharing his knowledge in research methodology, statistical skills and cardiac surgery. Your surgical skills and clinical knowledge have been of great inspiration to me and I am privileged to be able to address you as my surgical mentor. Other people think scientifically, you think science. Anders Roijer, MD, PhD, my co-supervisor, for instructing me in the great art of echocardiography, for being a supportive mentor, for inspirational talks and a great sense of humor leading to happy moments in our sessions at the echo lab. Carsten Lhrs, MD, my co-author and clinical mentor, for believing in me and trusting me, and not allowing me to give up after my first year in cardiothoracic surgery. Thank you for sharing your unique clinical knowledge and your highly trained surgical skills. Not being able to share the operating room with you anymore is a great personal loss, and your absence from the operating floor is a loss to the discipline of cardiothoracic surgery. Finally, without your database, this thesis would not have been possible. My co-author, Lars Algotsson, MD, PhD, for sharing his knowledge and experience in anesthesia and intensive care, and for providing a research-friendly atmosphere in the intensive care unit, affording great learning opportunities, and for taking care of my patients. I would also like to thank: Professor Stig Steen, Director of the Cardiothoracic Surgery Research in Lund, for providing an excellent scientific environment and for sharing his vast knowledge in cardiopulmonary research. Our secretary, Mrs. Birgitta Sjgren, for great professionalism and effective handling of patient records, for never saying no, and for always being glad to help. During this work I have collaborated with many colleagues for whom I have great regard, and I wish to extend my warmest thanks to all those who have helped me with my work at the Department of Cardiothoracic Surgery, Lund University Hospital. The staff of cardiothoracic wards 17 and 18, the OR and the ICU at Lund University Hospital, for taking care of the patients with great competence. To all my friends, especially Daniel, Servet and Johan P, who stuck with me through thick and thin, and who shared my joys and my sorrows. To my parents, Amir and Shahnaz: the proverb goes good parents give two things to their children: roots and wingsthank you for, despite the discouraging odds, giving me both. To my brother Shahin for being an inspiration and always leading me along the right path during times of mischief. Malin, Alice and Lily: thinking of you brings joy to my heart. Near or far, you are always with me. To my parents-in-law, for taking me into their arms and their family. Your passion and quest for natural experiences add a much-needed and appreciated dimension to my life. I am so grateful for your indomitable support of my family. To my beautiful daughter, Saga, you are the best thing that ever happened to me. I love you from the bottom of my heart. And above all, my wife Ann, you are the sea upon which I float. Without you, this would not have been possible. You mean the world to me. The research presented in this thesis was supported by grants from: Region Skne Health Care Lund University Hospital References  ADDIN REFMGR.REFLIST  (1) Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation 1978;58:20-4. (2) Dumesnil JG, Yoganathan AP. Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradients. Eur J Cardiothorac Surg 1992;6 Suppl 1:S34-S37. (3) Pibarot P, Honos GN, Durand LG, Dumesnil JG. The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical status. Can J Cardiol 1996;12:379-87. (4) Gonzalez-Juanatey JR, Garcia-Acuna JM, et al. Influence of the size of aortic valve prostheses on hemodynamics and change in left ventricular mass: implications for the surgical management of aortic stenosis. J Thorac Cardiovasc Surg 1996;112:273-80. (5) Dumesnil JG, Honos GN, Lemieux M, Beauchemin J. Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography. J Am Coll Cardiol 1990;16:637-43. (6) David TE, Armstrong S, Sun Z. Clinical and hemodynamic assessment of the Hancock II bioprosthesis. Ann Thorac Surg 1992;54:661-7. (7) Pibarot P, Dumesnil JG, Lemieux M, Cartier P, Metras J, Durand LG. Impact of prosthesis-patient mismatch on hemodynamic and symptomatic status, morbidity and mortality after aortic valve replacement with a bioprosthetic heart valve. J Heart Valve Dis 1998;7:211-8. (8) Schaff HV, Borkon AM, Hughes C, et al. Clinical and hemodynamic evaluation of the 19 mm Bjork-Shiley aortic valve prosthesis. Ann Thorac Surg 1981;32:50-7. (9) Pibarot P, Dumesnil JG. 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