Patient-prosthesis mismatch in mitral annuloplasty for degenerative mitral regurgitation: an ignored issue.
In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jg. 56 (2019-11-01), Heft 5, S. 976-982
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Zugriff:
Objectives: Elevated postoperative transmitral gradient (TMG), partially induced by a small annuloplasty ring, is associated with late atrial fibrillation (AF) after mitral valve repair. Here, we aimed to provide the optimal cut-off of prosthetic ring size to reduce patient-prosthesis mismatch (PPM) after mitral annuloplasty.
Methods: From 2006 to 2017, 262 patients who underwent mitral valve repair for degenerative pathologies were retrospectively studied. The relationships of body surface area (BSA)-indexed prosthetic orifice area (POAi)-postoperative TMG and POAi-late AF were tested using regression curves and receiver operating characteristic curves, respectively. The optimal cut-off of POAi predictive of late AF was used to define PPM. Baseline and follow-up data of patients with and without PPM were compared in propensity score-matched cohorts.
Results: In-hospital mortality was 0. Late AF was observed in 9.2% (24/262) patients during a median follow-up of 3.8 years. An exponential model was best fitted based on the POAi-postoperative TMG relationship (P < 0.001). Using late AF as the dependent variable, the optimal cut-off for PPM was POAi ≤2.28 cm2/m2 (c-statistic 0.71; sensitivity 0.61; specificity 0.80; P < 0.001). PPM was identified in 113 (43.1%) patients. After propensity score matching, the estimated 5-year rate of late AF was significantly higher in PPM patients than in non-PPM patients (24% vs 5%; P < 0.001).
Conclusions: Postoperative TMG increases significantly with a small POAi for full ring annuloplasty. A patient's BSA should be considered in addition to valvular dimensions during the selection of a proper ring size to reduce PPM-related AF.
(© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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Patient-prosthesis mismatch in mitral annuloplasty for degenerative mitral regurgitation: an ignored issue.
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Autor/in / Beteiligte Person: | Ma, W ; Shi, W ; Wu, W ; Ma, X ; Kong, Y ; Zhu, D ; Zhang, W |
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Zeitschrift: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jg. 56 (2019-11-01), Heft 5, S. 976-982 |
Veröffentlichung: | 2012-: Oxford, England : Oxford University Press ; <i>Original Publication</i>: [Berlin] : Springer International ; [Secaucus, NJ, USA : Springer-Verlag New York Inc., distributor, c1987-, 2019 |
Medientyp: | academicJournal |
ISSN: | 1873-734X (electronic) |
DOI: | 10.1093/ejcts/ezz086 |
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