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Influence of prosthesis-patient mismatch on diastolic heart failure after aortic valve replacement.

Nozohoor, Shahab LU ; Nilsson, Johan LU ; Lührs, Carsten LU ; Roijer, Anders LU and Sjögren, Johan LU (2008) In Annals of Thoracic Surgery 85(4). p.1310-1318
Abstract
BACKGROUND: Bioprostheses for supraannular placement have been developed to optimize the hemodynamic performance after aortic valve replacement. To evaluate the potential benefit of this design, we analyzed the influence of prosthesis-patient mismatch on diastolic function and left ventricular mass regression and evaluated the clinical performance of the Sorin Soprano and Medtronic Mosaic in the aortic position. METHODS: A total of 372 patients underwent aortic valve replacement between July 2004 and February 2007, receiving either a Sorin Soprano (n = 235) or a Medtronic Mosaic (n = 137) prosthetic valve. Echocardiographic and clinical data were collected prospectively, and follow-up was performed in April 2007. Multivariate analyses were... (More)
BACKGROUND: Bioprostheses for supraannular placement have been developed to optimize the hemodynamic performance after aortic valve replacement. To evaluate the potential benefit of this design, we analyzed the influence of prosthesis-patient mismatch on diastolic function and left ventricular mass regression and evaluated the clinical performance of the Sorin Soprano and Medtronic Mosaic in the aortic position. METHODS: A total of 372 patients underwent aortic valve replacement between July 2004 and February 2007, receiving either a Sorin Soprano (n = 235) or a Medtronic Mosaic (n = 137) prosthetic valve. Echocardiographic and clinical data were collected prospectively, and follow-up was performed in April 2007. Multivariate analyses were used to identify differences in hemodynamic performance, diastolic function, left ventricular mass regression, and predictors of impaired survival. Kaplan-Meier survival curves and log-rank tests were used to compare postoperative outcomes. RESULTS: The 30-day mortality was 1.7% (4 of 235 patients) in the Sorin Soprano group and 2.9% (4 of 137 patients) in the Medtronic Mosaic group (p = 0.473). Neither prosthesis-patient mismatch nor type of prosthesis was a significant predictor of early or late mortality. Diastolic heart failure was a predictor of poor survival (p = 0.004); however, the recovery of diastolic function was not significantly influenced by prosthesis-patient mismatch. Neither moderate (indexed effective orifice area < 0.85 cm(2)/m(2)) nor severe (indexed effective orifice area < 0.65 cm(2)/m(2)) prosthesis-patient mismatch resulted in a significantly impaired left ventricular mass regression. CONCLUSIONS: Prosthesis-patient mismatch was not an independent predictor of poor survival, impaired left ventricular mass regression, or recovery of diastolic function. The Sorin Soprano and the Medtronic Mosaic bioprostheses demonstrated comparable hemodynamic performance and excellent clinical outcome without signs of structural valve deterioration during follow-up. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Thoracic Surgery
volume
85
issue
4
pages
1310 - 1318
publisher
Elsevier
external identifiers
  • pmid:18355517
  • wos:000254083300027
  • scopus:40749128969
ISSN
1552-6259
DOI
10.1016/j.athoracsur.2007.12.069
language
English
LU publication?
yes
id
d2901c62-a694-488f-b7da-f8d053513e74 (old id 1052281)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18355517?dopt=Abstract
date added to LUP
2008-04-02 16:26:20
date last changed
2017-01-01 07:34:43
@article{d2901c62-a694-488f-b7da-f8d053513e74,
  abstract     = {BACKGROUND: Bioprostheses for supraannular placement have been developed to optimize the hemodynamic performance after aortic valve replacement. To evaluate the potential benefit of this design, we analyzed the influence of prosthesis-patient mismatch on diastolic function and left ventricular mass regression and evaluated the clinical performance of the Sorin Soprano and Medtronic Mosaic in the aortic position. METHODS: A total of 372 patients underwent aortic valve replacement between July 2004 and February 2007, receiving either a Sorin Soprano (n = 235) or a Medtronic Mosaic (n = 137) prosthetic valve. Echocardiographic and clinical data were collected prospectively, and follow-up was performed in April 2007. Multivariate analyses were used to identify differences in hemodynamic performance, diastolic function, left ventricular mass regression, and predictors of impaired survival. Kaplan-Meier survival curves and log-rank tests were used to compare postoperative outcomes. RESULTS: The 30-day mortality was 1.7% (4 of 235 patients) in the Sorin Soprano group and 2.9% (4 of 137 patients) in the Medtronic Mosaic group (p = 0.473). Neither prosthesis-patient mismatch nor type of prosthesis was a significant predictor of early or late mortality. Diastolic heart failure was a predictor of poor survival (p = 0.004); however, the recovery of diastolic function was not significantly influenced by prosthesis-patient mismatch. Neither moderate (indexed effective orifice area &lt; 0.85 cm(2)/m(2)) nor severe (indexed effective orifice area &lt; 0.65 cm(2)/m(2)) prosthesis-patient mismatch resulted in a significantly impaired left ventricular mass regression. CONCLUSIONS: Prosthesis-patient mismatch was not an independent predictor of poor survival, impaired left ventricular mass regression, or recovery of diastolic function. The Sorin Soprano and the Medtronic Mosaic bioprostheses demonstrated comparable hemodynamic performance and excellent clinical outcome without signs of structural valve deterioration during follow-up.},
  author       = {Nozohoor, Shahab and Nilsson, Johan and Lührs, Carsten and Roijer, Anders and Sjögren, Johan},
  issn         = {1552-6259},
  language     = {eng},
  number       = {4},
  pages        = {1310--1318},
  publisher    = {Elsevier},
  series       = {Annals of Thoracic Surgery},
  title        = {Influence of prosthesis-patient mismatch on diastolic heart failure after aortic valve replacement.},
  url          = {http://dx.doi.org/10.1016/j.athoracsur.2007.12.069},
  volume       = {85},
  year         = {2008},
}