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Impact of prosthesis-patient mismatch on exercise capacity in patients after bioprosthetic aortic valve replacement
  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. Daniel J Ruzicka (ruzicka{at}dhm.mhn.de)
        1. German Heart Center Munich, Germany
          1. Michael Wottke (wottke{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 Munich, Germany

                Abstract

                Objectives It is presumed that patient-prosthesis mismatch (PPM) influences morbidity and mortality after aortic valve replacement (AVR). The aim of our study was to determine the impact of PPM on physical capacity.

                Methods Six months after aortic valve replacement with a bioprosthesis, stress echocardiography was performed on a bicycle ergometer in 312 patients. Depending on gender, age and weight, the target exercise level for every patient was determined by a reference table. Maximum achieved workload is given as percentage of the predicted exercise capacity (PPEC). PPM was defined as an effective orifice area index ≤ 0.85cm2.

                Results PPM was present in 34.3% of the patients. In patients with or without PPM, age (72.5±6.9 vs 72.7±6.7 years, p=0.806), preoperative ejection fraction (p=0.557) and body surface area (1.85±0.21m2 vs 1.84±0.18m2, p=0.715) were not significantly different. Male gender was more frequent in patients without PPM (65.4% vs 45.8%, p=0.001). Patients without PPM achieved 65%±25% PPEC on the ergometer vs 57%±24% in patients with PPM (p=0.003). Stepwise linear regression analysis revealed the presence of PPM (p=0.007) and concomitant coronary revascularization (p=0.010) as significant influencing factors on PPEC.

                Conclusion The present study reveals a significant impact of PPM on physical capacity, measured by exercise testing, in patients after AVR. Although other factors as training status and comorbidity (e.g. concomitant coronary revascularization) also influence the achievement of higher exercise levels, our data strengthen the hypothesis that the avoidance of PPM could result in better exercise capacity for patients after AVR.

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