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You are here: Contents > 2012 > Volume 21 Number 2 March 2012 > AORTIC VALVE DISEASE > Impact of Aortic Stenosis Severity and its Interaction with Prosthesis-Patient Mismatch on Operative Mortality Following Aortic Valve Replacement

Impact of Aortic Stenosis Severity and its Interaction with Prosthesis-Patient Mismatch on Operative Mortality Following Aortic Valve Replacement

Nicolas Girerd, Patrick Mathieu, Jean G. Dumesnil, Julien Magne, Éric Charbonneau, François Dagenais, Éric Dumont, Pierre Voisine, Richard Baillot,Philippe Pibarot

Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Departments of Cardiology and Cardiac Surgery, Laval University, Québec, Canada

Background and aim of the study: The optimal timing of aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) is a source of debate. Moreover, it has been shown previously that prosthesis-patient mismatch (PPM) is an independent predictor of operative mortality after AVR. The study aim was to assess the effect of the preoperative severity of AS and its interaction with PPM with respect to operative mortality after AVR.
Methods: The data were analyzed from 2,104 consecutive patients who had undergone AVR for severe AS. The patients were allocated to tertiles according to their preoperative indexed aortic valve area (AVAi) as: <0.35 cm2/m2 , 0.35 to 0.43 cm2/m2, and >0.43 cm2/m2. PPM was defined as a projected postoperative indexed effective orifice area (EOAi) of the implanted prosthesis <0.85 cm2/m2.

Results: The operative mortality was 5.7% (n = 120). On multivariate analysis, an independent association was identified between the preoperative severity of AS and operative mortality (odds ratio [OR] = 2.00, p = 0.03 for AVAi <0.35 cm2/m2; OR = 1.39, p = 0.32 for AVAi 0.35-0.43 cm2/m2). Notably, the impact of PPM was more important in patients with more severe AS (p = 0.046 for AVAi × EOAi interaction).
Conclusion: The study results confirmed that very severe AS (AVAi <0.35 cm2/m2) is independently associated with operative mortality after AVR. The results also emphasized the importance of avoiding PPM in these patients.



The Journal of Heart Valve Disease 2012;21:158-167

Impact of Aortic Stenosis Severity and its Interaction with Prosthesis-Patient Mismatch on Operative Mortality Following Aortic Valve Replacement

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