PMID- 18039208
OWN - NLM
STAT- MEDLINE
DCOM- 20080220
LR  - 20161124
IS  - 0886-0440 (Print)
IS  - 0886-0440 (Linking)
VI  - 22
IP  - 6
DP  - 2007 Nov-Dec
TI  - Impact of valve prosthesis-patient mismatch on intermediate-term outcome and 
      regression of left ventricular mass following aortic valve replacement with 
      mechanical prosthesis.
PG  - 486-92
AB  - BACKGROUND: The impact of aortic valve replacement (AVR) with prosthesis-patient 
      mismatch (PPM) on intermediate-term outcome and left ventricular mass (LVM) 
      regression in patients with aortic stenosis (AS) was investigated. METHODS: One 
      hundred fifty patients with AS (87 pure stenosis and 63 combined stenosis and 
      regurgitation) were classified into a PPM group (n = 34, indexed effective 
      orifice area (EOAI) >0.65 cm(2)/m(2) and < or =0.85 cm(2)/m(2); moderate PPM) and 
      a non-PPM group (n = 116, EOAI > 0.85). Mean age, mean and peak aortic pressure 
      gradient (PG) were not different between the groups (PPM, 99.7 +/- 37.2 and 54.9 
      +/- 23.2 mmHg; non-PPM, 95.9 +/- 29.2 and 54.4 +/- 16.0 mmHg). The absolute and 
      relative regression in indexed left ventricular mass (LVMI) was estimated by 
      preoperative and postoperative echocardiography (n = 98). RESULTS: Twelve 
      patients died (valve-related death in 7) during 5 years of follow-up. Comparing 
      the PPM and non-PPM groups, overall survival (78.7% vs. 87.8%) and survival free 
      from valve-related death (96.8% vs. 92.1%) were not significantly different. New 
      York Heart Association (NYHA) functional class improved in all patients and there 
      were no patients in class III or IV. The postoperative mean PG was 14.6 +/- 6.1 
      mmHg in the PPM group and 9.4 +/- 3.8 mmHg in the non-PPM group (p = 0.0005), 
      with an inverse correlation (r = -0.48, p < 0.0001) between EOAI and the 
      postoperative mean PG. However, there was no significant difference in the 
      absolute and relative LVMI regression between the two groups. Multiple linear 
      regression analysis was performed and higher preoperative LVMI and mean aortic PG 
      were independent predictors of greater LVMI regression after AVR. CONCLUSIONS: 
      Moderate PPM does not appear to alter LVMI regression, NYHA class, or 
      intermediate-term outcome in AS patients undergoing AVR with mechanical 
      prostheses. In multivariate analysis, preoperative LVMI and mean aortic PG were 
      important independent predictors of LVMI regression.
FAU - Tao, Koji
AU  - Tao K
AD  - Department of Cardiovascular Surgery, Graduate School of Medicine, Kagoshima 
      University, Sakuragaoka, Kagoshima, Japan. koji-tao@sea.plala.or.jp
FAU - Sakata, Ryuzo
AU  - Sakata R
FAU - Iguro, Yoshifumi
AU  - Iguro Y
FAU - Ueno, Masahiro
AU  - Ueno M
FAU - Tanaka, Yasuhiro
AU  - Tanaka Y
FAU - Otsuji, Yutaka
AU  - Otsuji Y
FAU - Tei, Chuwa
AU  - Tei C
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Card Surg
JT  - Journal of cardiac surgery
JID - 8908809
SB  - IM
MH  - Aged
MH  - Aortic Valve/diagnostic imaging/*pathology/surgery
MH  - Disease Progression
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Heart Ventricles/diagnostic imaging/*pathology
MH  - Humans
MH  - Hypertrophy, Left Ventricular/diagnostic imaging/mortality/*prevention & control
MH  - Male
MH  - Prospective Studies
MH  - Reference Values
MH  - Stroke Volume
MH  - Time Factors
MH  - *Treatment Outcome
MH  - Ultrasonography
EDAT- 2007/11/28 09:00
MHDA- 2008/02/21 09:00
CRDT- 2007/11/28 09:00
PHST- 2007/11/28 09:00 [pubmed]
PHST- 2008/02/21 09:00 [medline]
PHST- 2007/11/28 09:00 [entrez]
AID - JCS465 [pii]
AID - 10.1111/j.1540-8191.2007.00465.x [doi]
PST - ppublish
SO  - J Card Surg. 2007 Nov-Dec;22(6):486-92. doi: 10.1111/j.1540-8191.2007.00465.x.