Ihsan Bakir1, Filip P. Casselman, Burak Onan1, Frank Van Praet, Yvette Vermeulen, Ivan Degrieck
OLV Clinic, Department of Cardiovascular and Thoracic Surgery, Aalst, Belgium
Background and aim of the study: The impact of a minimally invasive approach on patient-prosthesis mismatch (PPM) in patients undergoing aortic valve replacement (AVR) remains unknown. The study aim was to identify the impact of a minimally invasive approach for AVR on the incidence of PPM.
Methods: The results of a single-center experience in 506 patients who underwent isolated AVR through a minimally invasive or conventional sternotomy were analyzed. Postoperative PPM was defined as an effective orifice area index <0.85 cm2/m2, and was correlated with surgical approach, mortality and cardiac events after surgery.
Results: Overall, postoperative PPM was present in 26.0% of the patients. The ratio of PPM was 24.1% in minimal access patients and 27.7% in conventional AVR patients (p = 0.35). Hospital mortality was similar in both groups (3.8% versus 3.4%, p = 0.62).
The body mass index (BMI) was higher in patients with PPM (28.5 ± 4.4 versus 25.3 ± 3.6 kg/m2; p = 0.0001), but obesity was significantly associated with PPM (36.3% versus 9.4%; p = 0.0001). The PPM group included more patients with a left ventricular ejection fraction (LVEF) <0.50 (12.8% versus 5.3%; p = 0.004). The independent risk factors for PPM were increased BMI (p = 0.0001), LVEF <0.50 (p = 0.007) and preoperative aortic stenosis (p = 0.029). A LVEF <0.50 increased the risk for PPM by 3.77-fold (95% CI: 1.4-9.9), while a high BMI increased the risk by 1.42-fold (95% CI: 1.3-1.5). Preoperative aortic insufficiency was associated with PPM, but did not significantly increase the risk.
Conclusion: A minimally invasive approach for AVR did not lead to an increased incidence of PPM and associated adverse events following surgery.
The Journal of Heart Valve Disease 2014;23:161-167
|Does a Minimally Invasive Approach Increase the Incidence of Patient-Prosthesis Mismatch in Aortic Valve Replacement?|
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