Prevalence and long-term outcome of aortic prosthesis-patient mismatch in patients with paradoxical low-flow severe aortic stenosis

Authors: Mohty, Dania; Boulogne, Cyrille; Magne, JulienPibarot, Philippe; Echahidi, Najmeddine; Cornu, Elisabeth; Dumesnil, Jean G.; Laskar, Marc; Virot, Patrice; Aboyans, Victor
Abstract: Background—Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis–patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS. Methods and Results—Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm2). A PLF (indexed stroke volume =35 mL/m2) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area =0.85 cm2/m2 . The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P<0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P=0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5–4.45; P=0.0007). Conclusions—In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome
Document Type: Article de recherche
Issue Date: 9 September 2014
Open Access Date: Restricted access
Document version: VoR
This document was published in: Circulation, Vol. 130 (11 Suppl 1), S25–S31 (2014)
American Heart Association
Alternative version: 10.1161/CIRCULATIONAHA.113.007819
Collection:Articles publiés dans des revues avec comité de lecture

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