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.
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Figure 1 Comparison of Pre- With Postoperative Flow Rates for the 4 Valve Designs
Preoperative flow rates were set as 100%. A significant increase was observed for all valves postoperatively. Postoperative flow rates were significantly greater for biological valves compared with the mechanical groups (*p < 0.01) and within the biological group for stentless prosthesis (p < 0.05). At follow-up, coronary flow was lower compared with the early postoperative phase with the Advantage in favor of the stentless valve compared with the 3 other substitutes being maintained (p < 0.05).
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Figure 2 CFR 6 Months Postoperatively
Only the stentless Freestyle valve showed a normal coronary flow reserve (CFR) >2.5; the remaining 3 valve designs demonstrated comparable results with slightly reduced CFR.
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Figure 3 Reduced CFR in Patients With PPM for Hall Tilting Disc, Mosaic Stented, and Freestyle Stentless Valves
The results for stentless valves remained within normal ranges. Only 1 patient in the Advantage bileaflet group had patient-prosthesis-mismatch (PPM); therefore, evaluation of the results in this group was not relevant. CFR = coronary flow reserve.
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