AI Article Synopsis
- The study aimed to investigate how prosthesis-patient mismatch (PPM) affects early haemodynamic status and mortality in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS).
- It included 183 patients and found that PPM was present in about 28% of cases, but there were no significant differences in the vasoactive-inotropic dependency index (VDI) or other critical postoperative measurements between patients with and without PPM on the first days after surgery.
- The conclusions indicated that PPM does not significantly impact the early haemodynamic status or organ performance after AVR, suggesting that patients with PPM may not be at higher risk for complications in the immediate postoperative period.
Article Abstract
Objectives: Prosthesis-patient mismatch (PPM) has been reported to impact early haemodynamic status and early mortality after prosthetic aortic valve replacement (AVR) in patients with aortic stenosis (AS). The aim of this study was to assess the impact of PMM on early haemodynamic status after AVR using vasoactive-inotropic dependency index (VDI), postoperative pressures and end-organ perfusion.
Methods: A total of 183 patients with AS were included in this prospective cohort study, and underwent elective AVR with or without combined coronary artery bypass graft surgery. PPM was defined as a projected indexed effective orifice area of ≤0.85 cm/m, and was present in 27.9% of the patients. The primary end-point was the VDI [VDI = vasoactive-inotropic score/mean arterial pressure] measured upon admission to the intensive care unit (POD0) and on the morning of the first postoperative day (POD1). The secondary end-points were the following: mean left atrial pressure, mean central venous pressure, fluid balance, brain natriuretic peptide, troponin I, glomerular filtration rate and lactate levels on POD0 and POD1.
Results: No significant differences in VDI were observed between the no PPM and PPM groups on POD0 (0.08 ± 0.48 vs 0.05 ± 0.13, respectively, P = 0.622) or on POD1 (0.09 ± 0.40 vs 0.06 ± 0.13, respectively; P = 0.583). The mean arterial pressure, mean left atrial pressure, central venous pressure, troponin I, glomerular filtration rate and lactate levels did not differ between the two groups on POD0 and POD1, as well as fluid balance and brain natriuretic peptide on POD1.
Conclusions: PPM is not associated with early haemodynamic status impairment and end-organ perfusion after AVR.
Clinical Trial Number: ClinicalTrials.gov number, NCT00699673.
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| http://dx.doi.org/10.1093/icvts/ivw303 | DOI Listing |
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