CLINICAL RESEARCH: VALVULAR HEART DISEASE
Impact of Patient-Prosthesis Mismatch and Aortic Valve Design on Coronary Flow Reserve After Aortic Valve Replacement
Farhad Bakhtiary, MD*,*,
Mirko Schiemann, MD ,
Omer Dzemali, MD*,
Selami Dogan, MD*,
Volker Schächinger, MD, PhD ,
Hans Ackermann, MD, PhD ,
Anton Moritz, MD, PhD* and
Peter Kleine, MD, PhD*
* Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
Department of Cardiology and Electrophysiology, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany
Department of Biomedical Statistics, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany.
Manuscript received July 20, 2006;
revised manuscript received September 13, 2006,
accepted October 16, 2006.
* Reprint requests and correspondence: Dr. Farhad Bakhtiary, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany. (Email: farhad{at}bakhtiary.de).
OBJECTIVES: This prospective-randomized study investigated the effect of aortic valve design and patient-prosthesis mismatch (PPM) on coronary flow reserve (CFR) after mechanical or biological aortic valve replacement (AVR) in patients with aortic stenosis (AS).
BACKGROUND: Coronary flow reserve may be an important parameter of long-term survival after AVR in patients with AS. Reduced CFR may contribute to more cardiovascular events and greater rates of mortality.
METHODS: A total of 48 patients undergoing AVR underwent magnetic resonance imaging for the measurement of coronary flow preoperatively, 5 days postoperatively, and at 6-month follow-up with measurement of CFR. Patients scheduled for mechanical AVR were randomized to a tilting disc or bileaflet prosthesis (n = 12 in each group). For biological AVR, patients were scheduled to receive a stented (n = 12) or stentless (n = 12) valve. Patients also underwent echocardiography with measurement of transvalvular pressure gradients and left ventricular mass regression.
RESULTS: Postoperatively, coronary flow increased significantly in all groups (p < 0.001). Only stentless valves demonstrated a normal CFR (3.4 ± 0.3 vs. 2.3 ± 0.1 for stented biological valves, 2.1 ± 0.2 for tilting disc, and 2.2 ± 0.3 for bileaflet mechanical valves). Patient-prosthesis mismatch with an indexed effective orifice area <0.85 cm2/m2 led to decreased rates of CFR in the tilting disc, stentless, and stented groups. Pressure gradients were 14 ± 3 mm Hg for tilting disc, 12 ± 4 mm Hg for bileaflet, 19 ± 6 mm Hg for stented, and 10 ± 4 mm Hg for stentless valves.
CONCLUSIONS: Normalization of CFR after AVR in patients with AS was observed only for stentless valves. Coronary flow reserve might explain the excellent long-term results for stentless valves. (Impact of Patient-Prosthesis Mismatch on Coronary Flow Reserve; http://www.clinicaltrials.gov/ct/show/NCT00310947?order=1; NCT00310947
[ClinicalTrials.gov]
)
|
Abbreviations and Acronyms
| | AVR = aortic valve replacement | | CFR = coronary flow reserve | | iEOA = indexed effective orifice area | | LVMR = left ventricular mass regression | | MRI = magnetic resonance imaging | | PPM = patient-prosthesis mismatch | | RPP = rate-pressure product |
|
This article has been cited by other articles:
|
|
|
|
 
D. Kalavrouziotis, J. Rodes-Cabau, R. Bagur, D. Doyle, R. De Larochelliere, P. Pibarot, and E. Dumont
Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Small Aortic Annulus
J. Am. Coll. Cardiol.,
August 30, 2011;
58(10):
1016 - 1024.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Ali, A. Patel, Z. Ali, Y. Abu-Omar, A. Saeed, T. Athanasiou, and J. Pepper
Enhanced left ventricular mass regression after aortic valve replacement in patients with aortic stenosis is associated with improved long-term survival
J. Thorac. Cardiovasc. Surg.,
August 1, 2011;
142(2):
285 - 291.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Murtuza, J. R. Pepper, C. Jones, P. Nihoyannopoulos, A. Darzi, and T. Athanasiou
Does stentless aortic valve implantation increase perioperative risk? A critical appraisal of the literature and risk of bias analysis
Eur J Cardiothorac Surg,
May 1, 2011;
39(5):
643 - 652.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Y. Denault, A. Deschamps, and P. Couture
Intraoperative Hemodynamic Instability During and After Separation From Cardiopulmonary Bypass
Seminars in Cardiothoracic and Vascular Anesthesia,
September 1, 2010;
14(3):
165 - 182.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. Cohen, B. Zagorski, G. T. Christakis, C. D. Joyner, J. Vincent, J. Sever, S. Harbi, R. Feder-Elituv, F. Moussa, B. S. Goldman, et al.
Are stentless valves hemodynamically superior to stented valves? Long-term follow-up of a randomized trial comparing Carpentier-Edwards pericardial valve with the Toronto Stentless Porcine Valve
J. Thorac. Cardiovasc. Surg.,
April 1, 2010;
139(4):
848 - 859.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Pibarot and J. G. Dumesnil
Prosthetic Heart Valves: Selection of the Optimal Prosthesis and Long-Term Management
Circulation,
February 24, 2009;
119(7):
1034 - 1048.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Bakhtiary, O. Dzemali, U. Steinseiffer, C. Schmitz, B. Glasmacher, A. Moritz, and P. Kleine
Hydrodynamic comparison of biological prostheses during progressive valve calcification in a simulated exercise situation. An in vitro study
Eur J Cardiothorac Surg,
November 1, 2008;
34(5):
960 - 963.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Bottio, V. Tarzia, G. Rizzoli, and G. Gerosa
The changing spectrum of bioprostheses hydrodynamic performance: considerations on in-vitro tests
Interact CardioVasc Thorac Surg,
October 1, 2008;
7(5):
750 - 754.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
