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Influence of prosthesis-patient mismatch on left ventricular remodelling in severe aortic insufficiency.

Nozohoor, Shahab LU ; Nilsson, Johan LU ; Lührs, Carsten LU ; Roijer, Anders LU and Sjögren, Johan LU (2010) In European Journal of Cardio-thoracic Surgery 37. p.133-138
Abstract
Objective: The present study evaluates the impact of prosthesis-patient mismatch (PPM) on left ventricular remodelling following aortic valve replacement (AVR) for severe aortic insufficiency. Methods: In this study, 230 patients undergoing aortic valve surgery were divided into two groups depending on whether or not they exhibited PPM. Postoperative left ventricular (LV) dimensions and function were compared to the preoperative status. Results: The incidence of PPM (EOAi </=0.85cm(2)m(-2)) was 22.2%. There was no significant difference in the reduction of mean end-diastolic LV diameter (LVEDD; p=0.31) or mean end-systolic LV diameter (LVESD; p=0.79) between the non-PPM and the PPM groups. The LVEDD was reduced in the non-PPM group from... (More)
Objective: The present study evaluates the impact of prosthesis-patient mismatch (PPM) on left ventricular remodelling following aortic valve replacement (AVR) for severe aortic insufficiency. Methods: In this study, 230 patients undergoing aortic valve surgery were divided into two groups depending on whether or not they exhibited PPM. Postoperative left ventricular (LV) dimensions and function were compared to the preoperative status. Results: The incidence of PPM (EOAi </=0.85cm(2)m(-2)) was 22.2%. There was no significant difference in the reduction of mean end-diastolic LV diameter (LVEDD; p=0.31) or mean end-systolic LV diameter (LVESD; p=0.79) between the non-PPM and the PPM groups. The LVEDD was reduced in the non-PPM group from 66+/-9 to 55+/-9mm postoperatively (p<0.001) while the LVEDD in the PPM group was reduced from 65+/-9 to 56+/-10mm (p<0.001). The LVESD was reduced in the non-PPM group from 49+/-10 to 40+/-10mm postoperatively (p<0.001) while the LVESD in the PPM group was reduced from 50+/-11 to 39+/-10mm (p<0.001). Patients with preoperative LV dysfunction (ejection fraction (EF) <50%) demonstrated a significant improvement in postoperative LVEF in both the non-PPM (36+/-8% to 44+/-12%, p<0.001) and PPM groups (33+/-7% to 46+/-11%, p=0.001) but no significant difference could be demonstrated in the rate of improvement between the two groups (p=0.23). Furthermore, no significant difference was found in survival between patients with PPM and those without (p=0.23). Conclusions: PPM did not influence left ventricular remodelling or survival following AVR for severe aortic insufficiency. The left ventricular remodelling process was initiated regardless of preoperative LVEF, and the impact of PPM seems to be of little importance. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Cardio-thoracic Surgery
volume
37
pages
133 - 138
publisher
Elsevier
external identifiers
  • wos:000273195800025
  • pmid:19695896
  • scopus:72749087299
ISSN
1010-7940
DOI
10.1016/j.ejcts.2009.07.009
language
English
LU publication?
yes
id
5fa6d591-9868-4be6-b233-1dc8a64a2c6a (old id 1469529)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19695896?dopt=Abstract
date added to LUP
2009-09-08 08:59:29
date last changed
2018-05-29 09:57:29
@article{5fa6d591-9868-4be6-b233-1dc8a64a2c6a,
  abstract     = {Objective: The present study evaluates the impact of prosthesis-patient mismatch (PPM) on left ventricular remodelling following aortic valve replacement (AVR) for severe aortic insufficiency. Methods: In this study, 230 patients undergoing aortic valve surgery were divided into two groups depending on whether or not they exhibited PPM. Postoperative left ventricular (LV) dimensions and function were compared to the preoperative status. Results: The incidence of PPM (EOAi &lt;/=0.85cm(2)m(-2)) was 22.2%. There was no significant difference in the reduction of mean end-diastolic LV diameter (LVEDD; p=0.31) or mean end-systolic LV diameter (LVESD; p=0.79) between the non-PPM and the PPM groups. The LVEDD was reduced in the non-PPM group from 66+/-9 to 55+/-9mm postoperatively (p&lt;0.001) while the LVEDD in the PPM group was reduced from 65+/-9 to 56+/-10mm (p&lt;0.001). The LVESD was reduced in the non-PPM group from 49+/-10 to 40+/-10mm postoperatively (p&lt;0.001) while the LVESD in the PPM group was reduced from 50+/-11 to 39+/-10mm (p&lt;0.001). Patients with preoperative LV dysfunction (ejection fraction (EF) &lt;50%) demonstrated a significant improvement in postoperative LVEF in both the non-PPM (36+/-8% to 44+/-12%, p&lt;0.001) and PPM groups (33+/-7% to 46+/-11%, p=0.001) but no significant difference could be demonstrated in the rate of improvement between the two groups (p=0.23). Furthermore, no significant difference was found in survival between patients with PPM and those without (p=0.23). Conclusions: PPM did not influence left ventricular remodelling or survival following AVR for severe aortic insufficiency. The left ventricular remodelling process was initiated regardless of preoperative LVEF, and the impact of PPM seems to be of little importance.},
  author       = {Nozohoor, Shahab and Nilsson, Johan and Lührs, Carsten and Roijer, Anders and Sjögren, Johan},
  issn         = {1010-7940},
  language     = {eng},
  pages        = {133--138},
  publisher    = {Elsevier},
  series       = {European Journal of Cardio-thoracic Surgery},
  title        = {Influence of prosthesis-patient mismatch on left ventricular remodelling in severe aortic insufficiency.},
  url          = {http://dx.doi.org/10.1016/j.ejcts.2009.07.009},
  volume       = {37},
  year         = {2010},
}