TY - JOUR
T1 - Impact of Pre-Existing Prosthesis-Patient Mismatch on Survival Following Aortic Valve-in-Valve Procedures
AU - Pibarot, Philippe
AU - Simonato, Matheus
AU - Barbanti, Marco
AU - Linke, Axel
AU - Kornowski, Ran
AU - Rudolph, Tanja
AU - Spence, Mark
AU - Moat, Neil
AU - Aldea, Gabriel
AU - Mennuni, Marco
AU - Iadanza, Alessandro
AU - Amrane, Hafid
AU - Gaia, Diego
AU - Kim, Won Keun
AU - Napodano, Massimo
AU - Baumbach, Hardy
AU - Finkelstein, Ariel
AU - Kobayashi, Junjiro
AU - Brecker, Stephen
AU - Don, Creighton
AU - Cerillo, Alfredo
AU - Unbehaun, Axel
AU - Attias, David
AU - Nejjari, Mohammed
AU - Jones, Noah
AU - Fiorina, Claudia
AU - Tchetche, Didier
AU - Philippart, Raphael
AU - Spargias, Konstantinos
AU - Hernandez, Jose Maria
AU - Latib, Azeem
AU - Dvir, Danny
N1 - Funding Information:
Dr. Pibarot is the Canada Research Chair in Valvular Heart Disease; his research program is funded by the Canadian Institutes of Health Research (grant FDN-143225); and has received research grants from Edwards Lifesciences and Medtronic for echocardiography core laboratory analyses in transcatheter heart valves. Dr. Dvir is a consultant for Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr. Moat has received consulting and speaking fees from Abbott, Edwards Lifesciences, and Medtronic. Dr. Latib is a consultant for Medtronic; has received speaking honoraria from Abbott Vascular; and research grants from Medtronic and Edwards Lifesciences. Dr. Kim is a proctor for Symetis and St. Jude Medical. Dr. Linke is a consultant for Medtronic, St. Jude Medical, Claret Medical, Boston Scientific, Edwards Lifesciences, Symetis, and Bard; and owns stock options in Claret Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/1/22
Y1 - 2018/1/22
N2 - 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 cm 2 /m 2 if body mass index is <30 kg/m 2 and <0.6 cm 2 /m 2 if BMI is ≥30 kg/m 2 . 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 = 0.01) and 1-year (unadjusted: 28.6%, p < 0.001; adjusted: 19.3%, p = 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 = 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.
AB - 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 cm 2 /m 2 if body mass index is <30 kg/m 2 and <0.6 cm 2 /m 2 if BMI is ≥30 kg/m 2 . 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 = 0.01) and 1-year (unadjusted: 28.6%, p < 0.001; adjusted: 19.3%, p = 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 = 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.
KW - prosthesis-patient-mismatch
KW - transcatheter aortic valve replacement
KW - valve-in-valve
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U2 - 10.1016/j.jcin.2017.08.039
DO - 10.1016/j.jcin.2017.08.039
M3 - Article
C2 - 29348008
AN - SCOPUS:85040585193
VL - 11
SP - 133
EP - 141
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 2
ER -
