Prosthesis-Patient Mismatch after Aortic Valve Replacement with the Mosaic Ultra Bioprosthesis.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Thoracic and Cardiovascular Surgeon Pub Date : 2024-04-01 Epub Date: 2023-04-09 DOI:10.1055/s-0043-1768033
Vasileios Ntinopoulos, Hector Rodriguez Cetina Biefer, Stak Dushaj, Laura Rings, Philine Fleckenstein, Omer Dzemali, Achim Haeussler
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Abstract

Background:  Several studies have reported high rates of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) with the Mosaic prosthesis. This work assesses the incidence of PPM after AVR with a modified version of the Mosaic prosthesis, the Mosaic Ultra.

Methods:  We performed a retrospective analysis of the data of 532 patients who underwent AVR with implantation of the Mosaic Ultra prosthesis in the period 2007-2016 in our institution. Patients were classified according to their indexed effective orifice area (EOAi) to severe (EOAi < 0.65 cm2/m2), moderate (EOAi 0.65-0.85 cm2/m2), and absent/mild PPM (EOAi > 0.85 cm2/m2). In-hospital postoperative outcomes and the impact of PPM on mean transvalvular pressure gradient after stratification by prosthesis size were assessed.

Results:  Overall, 3 (0.6%) patients had severe, 92 (17.3%) moderate, and 437 (82.1%) absent/mild PPM. There was a significant difference in PPM proportions (moderate/severe vs absent/mild PPM) across different prosthesis sizes overall (p < 0.0001), observing gradually increasing rates of PPM with decreasing prosthesis sizes. Patients with moderate/severe PPM had higher mean transvalvular pressure gradients (19 [13-25] vs 13 [10-17] mm Hg, p < 0.0001) than patients with absent/mild PPM. There was a significant difference in mean transvalvular pressure gradient between the different aortic valve prosthesis sizes overall (p < 0.0001), observing gradually increasing gradients with decreasing prosthesis sizes.

Conclusion:  Patients undergoing AVR with the smaller sized (19, 21, and 23 mm) Mosaic Ultra aortic valve prostheses exhibit a higher risk for moderate/severe PPM and higher mean aortic transvalvular pressure gradients than patients receiving the larger sized (25, 27, and 29 mm) prostheses.

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使用 Mosaic Ultra 生物假体进行主动脉瓣置换术后假体与患者的不匹配。
背景:一些研究报告称,使用马赛克假体进行主动脉瓣置换术(AVR)后,假体与患者不匹配(PPM)的发生率很高。本研究评估了使用改良版 Mosaic 人工关节(Mosaic Ultra)进行主动脉瓣置换术后 PPM 的发生率:我们对 2007-2016 年期间在本院接受 AVR 并植入 Mosaic Ultra 假体的 532 例患者的数据进行了回顾性分析。根据患者的有效孔面积(EOAi)指数将其分为重度(EOAi 2/m2)、中度(EOAi 0.65-0.85 cm2/m2)和无/轻度 PPM(EOAi > 0.85 cm2/m2)。根据假体大小进行分层后,评估了院内术后结果以及PPM对平均跨瓣压力梯度的影响:总体而言,3 例(0.6%)患者有重度 PPM,92 例(17.3%)有中度 PPM,437 例(82.1%)无/轻度 PPM。不同尺寸的假体在 PPM 比例(中度/重度 vs 缺失/轻度 PPM)上存在明显差异(P P P 结论:使用较小尺寸的假体进行房室重建的患者在 PPM 比例(中度/重度 vs 缺失/轻度 PPM)上存在明显差异:与接受较大尺寸(25、27 和 29 毫米)人工瓣膜的患者相比,接受较小尺寸(19、21 和 23 毫米)Mosaic Ultra 主动脉瓣人工瓣膜的患者出现中度/重度 PPM 的风险更高,平均主动脉跨瓣压力梯度也更高。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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