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Prediction of valve prosthesis-patient mismatch prior to aortic valve replacement: which is the best method?
  1. Sabine Bleiziffer (bleiziffer{at}dhm.mhn.de)
  1. German Heart Center Munich, Germany
    1. Walter B Eichinger (eichinger{at}dhm.mhn.de)
    1. German Heart Center Munich, Germany
      1. Ina Hettich (wagner{at}dhm.mhn.de)
      1. German Heart Center Munich, Germany
        1. Ralf Guenzinger (guenzinger{at}dhm.mhn.de)
        1. German Heart Center Munich, Germany
          1. Daniel Ruzicka (ruzicka{at}dhm.mhn.de)
          1. German Heart Center Munich, Germany
            1. Robert Bauernschmitt (bauernschmitt{at}dhm.mhn.de)
            1. German Heart Center Munich, Germany
              1. Ruediger Lange (lange{at}dhm.mhn.de)
              1. German Heart Center, Germany

                Abstract

                Objective To predict the occurrence of valve prosthesis-patient mismatch (VP-PM) after aortic valve replacement (AVR), the surgeon needs to estimate the postoperative indexed effective orifice area (EOAI). The aim of this study was to compare different methods of predicting VP-PM.

                Methods The effective orifice area (EOA) of 383 patients who had undergone AVR between July 2000 and January 2005 with various aortic valve prostheses was obtained echocardiographically 6 months postoperatively. We tested the efficacy of (#1) EOAI calculated from echo data obtained in our own laboratory, (#2) indexed geometric orifice area (GOAI), (#3) EOAI estimated from charts provided by prosthesis manufacturers (which are based either on in-vitro or on echo data), and (#4) EOAI estimated from reference echo data published in the literature to predict VP-PM.

                Results Sensitivity and specifity to predict VP-PM were 53% and 83% (method #1), 80% and 53% (charts based on echo data, parts of method #3), and 71% and 67% (method #4) using echocardiography-derived reference data. The sensitivity of method #2 and of charts based on in-vitro data (parts of method #3) to predict VP-PM was 0-17%. The incidence of severe VP-PM could be reduced from 8.7% to 0.8% after the introduction of the systematic estimation of the EOAI at the time of operation (p=0.003, Method #1).

                Conclusions The best method of predicting VP-PM is the use of echocardiography-derived mean EOAs, while the use of in- vitro data or the GOA is unreliable. After the surgeon’s anticipation of VP-PM prior to AVR, the incidence of VP- PM could be reduced.

                • echocardiography
                • prosthesis
                • surgery
                • valves

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