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. 2020 Jan;114(1):12-22.
doi: 10.5935/abc.20190231.

Determinants of Aortic Prosthesis Mismatch in a Brazilian Public Health System Hospital: Big Patients or Small Prosthesis?

[Article in English, Portuguese]
Maria Estefania Otto  1 , Fernando Antibas Atik  1 , Marcelo do Nascimento Moreira  1 , Luiz Carlos Madruga Ribeiro  1 , Bianca Corrêa Rocha de Mello  1 , Joyce Gomes Elias Lima  1 , Maiara Sanchez Ribeiro  1 , Ana Carolina Pereira Matos Domingues  1 , Reyna Pinheiro Calzada  1 , Armindo Jreige Jr  1 , Larissa Lucas Schloicka  1 , Philippe Pibarot  2
Affiliations

Determinants of Aortic Prosthesis Mismatch in a Brazilian Public Health System Hospital: Big Patients or Small Prosthesis?

[Article in English, Portuguese]
Maria Estefania Otto et al. Arq Bras Cardiol. 2020 Jan.

Abstract

Background: Prosthesis-patient mismatch (PPM) is associated with worse outcomes.

Objective: Determine the frequency and evaluate preoperatory variables independently associated with severe PPM in a tertiary hospital focused on Public Health Care.

Methods: A total of 316 patients submitted to aortic valve replacement, who had echocardiography performed within the first 30 days after surgery, were retrospectively analyzed. The indexed effective orifice area (iEOA) of the prosthesis was used to classify the patients into three groups, according to PPM, considering body mass index (BMI): severe PPM (iEOA) < 0.65 cm2/m2), mild to moderate PPM (iEOA, 0.65 cm2/m2 - 0.85 cm2/m2) and without PPM (iEOA > 0.85 cm2/m2) for a BMI < 30 kg/m2 and severe PPM (iEOA) < 0.55 cm2/m2), mild to moderate (iEOA, 0.55 cm2/m2- 0.70 cm2/m2) and without PPM (iEOA > 0.7 cm2/m2) for a BMI > 30 kg/m2. Statistical significance was considered when p < 0.05.

Results: iEOA was obtained in 176 patients. The frequency of severe and moderate PPM was 33.4% and 36.2%, respectively. Severe PPM patients were younger and had larger BMI, but smaller left ventricular outflow tract diameter (LVOTD). The independent variables used to predict severe PPM were male gender, BMI > 25 kg/m2, age < 60 years, LVOTD < 21 mm, and rheumatic etiology with an area under the ROC curve of 0.82.

Conclusion: The frequency of severe PPM is high in a Brazilian population representative of the Public Health System, and it is possible to predict PPM from preoperative variables such as rheumatic valvular disease, gender, BMI, age and LVOTD.

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Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
ROC curve: accuracy of the multivariable model for prediction of severe PPM (Definition #2:)
See this image and copyright information in PMC

Comment in

References

    1. Lancellotti P, Pibarot P, Chambers J, Edvardsen T, Delgado V, Dulghero R, et al. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(6):589–590. - PubMed
    1. Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation. 1978;58(1):20–24. - PubMed
    1. Head SJ, Mokhles MM, Osnabrugge RL, Pibarot P, Mack MG, Takkenbert JJ, et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J. 2012;33(12):1518–1529. - PubMed
    1. Pibarot P, Dumesnil JG. Valve prosthesis-patient mismatch, 1978 to 2011: from original concept to compelling evidence. J Am Coll Cardiol. 2012;60(13):1136–1139. - PubMed
    1. Mohty D, Malouf JF, Girard SE, Schaff HV, Grill DE, Enriquez-Sarano ME, et al. Impact of prosthesis-patient mismatch on long-term survival in patients with small St Jude Medical mechanical prostheses in the aortic position. Circulation. 2006;113(3):420–426. - PubMed