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Impact of Pre-existing Prosthesis-Patient Mismatch on Survival Following Aortic Valve-in-Valve Procedures

Pibarot, P; Simonato, M; Barbanti, M; Linke, A; Kornowski, R; Rudolph, T; Spence, M; Moat, N; Aldea, G; Mennuni, M; et al. Pibarot, P; Simonato, M; Barbanti, M; Linke, A; Kornowski, R; Rudolph, T; Spence, M; Moat, N; Aldea, G; Mennuni, M; Iadanza, A; Amrane, H; Gaia, D; Kim, W-K; Napodano, M; Baumbach, H; Finkelstein, A; Kobayashi, J; Brecker, S; Don, C; Cerillo, A; Unbehaun, A; Attias, D; Nejjari, M; Jones, N; Fiorina, C; Tchetche, D; Philippart, R; Spargias, K; Hernandez, J-M; Latib, A; Dvir, D (2018) Impact of Pre-existing Prosthesis-Patient Mismatch on Survival Following Aortic Valve-in-Valve Procedures. JACC: Cardiovascular Interventions, 11 (2). pp. 133-141. ISSN 1876-7605 https://doi.org/10.1016/j.jcin.2017.08.039
SGUL Authors: Brecker, Stephen

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Abstract

OBJECTIVES The aim of this study was to determine whether the association of small label size of the surgical valve with increased mortality after transcatheter valve-in-valve (ViV) implantation is, at least in part, related to pre-existing prosthesis-patient mismatch (PPM) (i.e., a bioprosthesis that is too small in relation to body size). BACKGROUND Transcatheter ViV implantation is an alternative for the treatment of patients with degenerated bioprostheses. Small label size of the surgical valve has been associated with increased mortality after ViV implantation. METHODS Data from 1,168 patients included in the VIVID (Valve-in-Valve International Data) registry were analyzed. Pre-existing PPM of the surgical valve was determined using a reference value of effective orifice area for each given model and size of implanted prosthetic valve indexed for body surface area. Severe PPM was defined according to the criteria proposed by the Valve Academic Research Consortium 2: indexed effective orifice area <0.65 cm2/m2 if body mass index is <30 kg/m2 and <0.6 cm2/m2 if BMI is $30 kg/m2. The primary study endpoint was 1-year mortality. RESULTS Among the 1,168 patients included in the registry, 89 (7.6%) had pre-existing severe PPM. Patients with severe PPM had higher 30-day (10.3%, p ¼ 0.01) and 1-year (unadjusted: 28.6%, p < 0.001; adjusted: 19.3%, p ¼ 0.03) mortality rates compared with patients with no severe PPM (4.3%, 11.9%, and 10.9%, respectively). After adjusting for surgical valve label size, Society of Thoracic Surgeons score, renal failure, diabetes, and stentless surgical valves, presence of pre-existing severe PPM was associated with increased risk for 1-year mortality (odds ratio: 1.88; 95% confidence interval: 1.07 to 3.28; p ¼ 0.03). Patients with severe PPM also more frequently harbored high post-procedural gradients (mean gradient $20 mm Hg). CONCLUSIONS Pre-existing PPM of the failed surgical valve is strongly and independently associated with increased risk for mortality following ViV implantation.

Item Type: Article
Additional Information: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: 1102 Cardiovascular Medicine And Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: JACC: Cardiovascular Interventions
ISSN: 1876-7605
Dates:
DateEvent
22 January 2018Published
15 January 2018Published Online
29 August 2017Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Projects:
Project IDFunderFunder ID
FDN-143225Canadian Institutes of Health Researchhttp://dx.doi.org/10.13039/501100000024
URI: https://openaccess.sgul.ac.uk/id/eprint/109457
Publisher's version: https://doi.org/10.1016/j.jcin.2017.08.039

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