Response to Letter Regarding Article, “Long-Term Outcomes After Valve Replacement for Low-Gradient Aortic Stenosis: Impact of Prosthesis-Patient Mismatch”
2006; Lippincott Williams & Wilkins; Volume: 114; Issue: 23 Linguagem: Inglês
10.1161/circulationaha.106.665018
ISSN1524-4539
AutoresAlexander Kulik, Varun Kapila, Thierry Mesana, Marc Ruel, Ian G. Burwash,
Tópico(s)Cardiac Imaging and Diagnostics
ResumoHomeCirculationVol. 114, No. 23Response to Letter Regarding Article, "Long-Term Outcomes After Valve Replacement for Low-Gradient Aortic Stenosis: Impact of Prosthesis-Patient Mismatch" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article, "Long-Term Outcomes After Valve Replacement for Low-Gradient Aortic Stenosis: Impact of Prosthesis-Patient Mismatch" Alexander Kulik, MD, Varun Kapila, MD, Thierry G. Mesana, MD, PhD and Marc Ruel, MD, MPH Ian G. Burwash, MD Alexander KulikAlexander Kulik Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada , Varun KapilaVarun Kapila Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada , Thierry G. MesanaThierry G. Mesana Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada and Marc RuelMarc Ruel Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada Ian G. BurwashIan G. Burwash Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada Originally published5 Dec 2006https://doi.org/10.1161/CIRCULATIONAHA.106.665018Circulation. 2006;114:e628We thank Bleiziffer and colleagues for their interest and insightful comments regarding our article1 describing long-term outcomes after valve replacement for patients with low-gradient aortic stenosis. In our analyses, prosthesis-patient mismatch (PPM) was characterized as an indexed effective orifice area (EOA) of ≤0.85 cm2/m2 because this definition constitutes the most generally accepted criterion for PPM.2 As Bleiziffer et al note in their letter, the use of geometric internal orifice area as a measure of prosthesis size is limited and does not effectively predict hemodynamic or clinical outcomes. We did not use geometric orifice area in our analyses because geometric orifice area does not account for many valve characteristics that contribute to the EOA, such as prosthesis height, profile, opening angle, and leaflet inertia.We agree with Bleiziffer and colleagues that the EOA derived by Doppler echo continuity equation from individual patients after implantation of the prosthesis may have better quantified the degree of PPM in our study of low-gradient aortic stenosis patients. This methodology has several important limitations, however, related to the difficulties caused by prosthetic valve reverberations in accurately measuring left ventricular outflow diameter after surgery. Moreover, the presence of large localized transprosthetic gradients or nonuniform transprosthetic spatial velocity profiles frequently result in large discrepancies between Doppler echo and actual EOA measurements.3,4 Therefore, we used fixed values of in vivo EOAs (also known as projected EOAs) for each prosthesis type and size from literature sources of patients with normally functioning prostheses.2 Projected EOA values can be attributed to patients who have not yet been echocardiographically examined with their new valve prosthesis, and projected EOA values may also be applied in advance of surgery.EOAs derived from individual patients are obviously not available at the time of surgical decision making. The EOA can only be determined after the prosthesis has been inserted, the patient has been weaned from cardiopulmonary bypass, and the preload, afterload, and contractility have normalized. Therefore, the EOA of an individual patient (determined after surgery) has little or no role in predicting whether PPM will be avoided with a given prosthesis type and size. From a practical perspective, projected EOAs have greater interpretability and predictability for surgeons performing aortic valve replacement because projected EOAs can be used to decide whether another prosthesis type or size should be selected or whether aortic root enlargement should be performed before implantation of the prosthetic valve. This provided the rationale for our analyses.DisclosuresNone.1 Kulik A, Burwash IG, Kapila V, Mesana TG, Ruel M. Long-term outcomes after valve replacement for low-gradient aortic stenosis: impact of prosthesis-patient mismatch. Circulation. 2006; 114 (suppl I): I-553–I-558.LinkGoogle Scholar2 Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol. 2000; 36: 1131–1141.CrossrefMedlineGoogle Scholar3 Baumgartner H, Khan S, DeRobertis M, Czer L, Maurer G. Effect of prosthetic aortic valve design on the Doppler-catheter gradient correlation: an in vitro study of normal St. Jude, Medtronic-Hall, Starr-Edwards and Hancock valves. J Am Coll Cardiol. 1992; 19: 324–332.CrossrefMedlineGoogle Scholar4 Henneke KH, Pongratz G, Bachmann K. Limitations of Doppler echocardiography in the assessment of prosthetic valve hemodynamics. J Heart Valve Dis. 1995; 4: 18–25.MedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Sá M, Zhigalov K, Cavalcanti L, Escorel Neto A, Rayol S, Weymann A, Ruhparwar A and Lima R (2021) Impact of Aortic Annulus Enlargement on the Outcomes of Aortic Valve Replacement: A Meta-analysis, Seminars in Thoracic and Cardiovascular Surgery, 10.1053/j.semtcvs.2020.06.046, 33:2, (316-325), Online publication date: 1-Oct-2022. Amer M, Mosleh W, Memon S, Joshi S, Sullivan B, Sharkawi M, Mather J, Kiernan F, McMahon S, Duvall W and McKay R (2020) Comparison of Benefit of Transcatheter Aortic Valve Implantation in Patients With Low Gradient Versus High Gradient Aortic Stenosis and Left Ventricular Dysfunction, The American Journal of Cardiology, 10.1016/j.amjcard.2020.02.019, 125:10, (1543-1549), Online publication date: 1-May-2020. Sá M, Carvalho M, Sobral Filho D, Cavalcanti L, Diniz R, Rayol S, Soares A, Sá F, Menezes A, Clavel M, Pibarot P and Lima R (2019) Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients, Interactive CardioVascular and Thoracic Surgery, 10.1093/icvts/ivy364, 29:1, (74-82), Online publication date: 1-Jul-2019. Annabi M, Clavel M and Pibarot P (2019) Dobutamine Stress Echocardiography in Low‐Flow, Low‐Gradient Aortic Stenosis: Flow Reserve Does Not Matter Anymore, Journal of the American Heart Association, 8:6, Online publication date: 19-Mar-2019. Pibarot P, Magne J, Leipsic J, Côté N, Blanke P, Thourani V and Hahn R (2019) Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement, JACC: Cardiovascular Imaging, 10.1016/j.jcmg.2018.10.020, 12:1, (149-162), Online publication date: 1-Jan-2019. Nardy V, Crestanello J and Jaik N (2018) Aortic Valve Replacement in Patients With Congestive Heart Failure Encyclopedia of Cardiovascular Research and Medicine, 10.1016/B978-0-12-809657-4.10917-2, (143-161), . Crestanello J (2018) OBSOLETE: Aortic Valve Replacement in Patients with Congestive Heart Failure Reference Module in Biomedical Sciences, 10.1016/B978-0-12-801238-3.10917-1, . Steiner J, Rodés-Cabau J, Holmes D, LeWinter M and Dauerman H (2017) Mechanical Intervention for Aortic Valve Stenosis in Patients With Heart Failure and Reduced Ejection Fraction, Journal of the American College of Cardiology, 10.1016/j.jacc.2017.10.040, 70:24, (3026-3041), Online publication date: 1-Dec-2017. Witberg G, Finkelstein A, Barbash I, Assali A, Shapira Y, Segev A, Halkin A, Fefer P, Ben-Shoshan J, Konigstein M, Sagie A, Guetta V, Kornowski R and Barsheshet A (2017) Prognostic significance of aortic valve gradient in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, Catheterization and Cardiovascular Interventions, 10.1002/ccd.27124, 90:7, (1175-1182), Online publication date: 1-Dec-2017. Dahou A, Mahjoub H and Pibarot P (2016) Prosthesis-Patient Mismatch After Aortic Valve Replacement, Current Treatment Options in Cardiovascular Medicine, 10.1007/s11936-016-0488-0, 18:11, Online publication date: 1-Nov-2016. Davin L, Dulgheru R, Bernard A, Marchetta S, Piérard L and Lancellotti P (2016) Multimodality imaging for the diagnosis and assessment of aortic stenosis severity, Expert Review of Cardiovascular Therapy, 10.1080/14779072.2016.1213630, 14:10, (1177-1188), Online publication date: 2-Oct-2016. Une D, Mesana L, Chan V, Maklin M, Chan R, Masters R, Mesana T and Ruel M (2015) Clinical Impact of Changes in Left Ventricular Function After Aortic Valve Replacement, Circulation, 132:8, (741-747), Online publication date: 25-Aug-2015. Rader F, Sachdev E, Arsanjani R and Siegel R (2015) Left Ventricular Hypertrophy in Valvular Aortic Stenosis: Mechanisms and Clinical Implications, The American Journal of Medicine, 10.1016/j.amjmed.2014.10.054, 128:4, (344-352), Online publication date: 1-Apr-2015. Urena M, Webb J, Eltchaninoff H, Muñoz-García A, Bouleti C, Tamburino C, Nombela-Franco L, Nietlispach F, Moris C, Ruel M, Dager A, Serra V, Cheema A, Amat-Santos I, de Brito F, Lemos P, Abizaid A, Sarmento-Leite R, Ribeiro H, Dumont E, Barbanti M, Durand E, Alonso Briales J, Himbert D, Vahanian A, Immè S, Garcia E, Maisano F, del Valle R, Benitez L, García del Blanco B, Gutiérrez H, Perin M, Siqueira D, Bernardi G, Philippon F and Rodés-Cabau J (2015) Late Cardiac Death in Patients Undergoing Transcatheter Aortic Valve Replacement, Journal of the American College of Cardiology, 10.1016/j.jacc.2014.11.027, 65:5, (437-448), Online publication date: 1-Feb-2015. Amabile N, Agostini H, Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Laskar M and Caussin C (2014) Impact of low preprocedural transvalvular gradient on cardiovascular mortality following TAVI: an analysis from the FRANCE 2 registry, EuroIntervention, 10.4244/EIJV10I7A144, 10:7, (842-849), Online publication date: 1-Nov-2014. Popma J and Khabbaz K (2014) Prosthesis-Patient Mismatch After "High-Risk" Aortic Valve Replacement∗, Journal of the American College of Cardiology, 10.1016/j.jacc.2014.07.952, 64:13, (1335-1338), Online publication date: 1-Sep-2014. Rassi A, Pibarot P and Elmariah S (2014) Left Ventricular Remodelling in Aortic Stenosis, Canadian Journal of Cardiology, 10.1016/j.cjca.2014.04.026, 30:9, (1004-1011), Online publication date: 1-Sep-2014. Sebag F, Lellouche N, Chaachoui N, Dubois-Rande J, Gueret P and Monin J (2014) Prevalence and clinical impact of QRS duration in patients with low-flow/low-gradient aortic stenosis due to left ventricular systolic dysfunction, European Journal of Heart Failure, 10.1002/ejhf.63, 16:6, (639-647), Online publication date: 1-Jun-2014. Beach J, Mihaljevic T, Rajeswaran J, Marwick T, Edwards S, Nowicki E, Thomas J, Svensson L, Griffin B, Gillinov A and Blackstone E (2014) Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for aortic stenosis, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2012.12.016, 147:1, (362-369.e8), Online publication date: 1-Jan-2014. Elmariah S, Palacios I, McAndrew T, Hueter I, Inglessis I, Baker J, Kodali S, Leon M, Svensson L, Pibarot P, Douglas P, Fearon W, Kirtane A, Maniar H and Passeri J (2013) Outcomes of Transcatheter and Surgical Aortic Valve Replacement in High-Risk Patients With Aortic Stenosis and Left Ventricular Dysfunction, Circulation: Cardiovascular Interventions, 6:6, (604-614), Online publication date: 1-Dec-2013. O'Sullivan C, Stortecky S, Heg D, Pilgrim T, Hosek N, Buellesfeld L, Khattab A, Nietlispach F, Moschovitis A, Zanchin T, Meier B, Windecker S and Wenaweser P (2013) Clinical outcomes of patients with low-flow, low-gradient, severe aortic stenosis and either preserved or reduced ejection fraction undergoing transcatheter aortic valve implantation, European Heart Journal, 10.1093/eurheartj/eht408, 34:44, (3437-3450), Online publication date: 21-Nov-2013., Online publication date: 21-Nov-2013. Orwat S, Kaleschke G, Kerckhoff G, Radke R and Baumgartner H (2013) Low flow, low gradient severe aortic stenosis: diagnosis, treatment and prognosis, EuroIntervention, 10.4244/EIJV9SSA8, 9:S, (S38-S42), Online publication date: 1-Sep-2013. Amabile N, Ramadan R, Ghostine S, Cheng S, Azmoun A, Raoux F, To N, Haddouche Y, Troussier X, Nottin R and Caussin C (2013) Early and mid-term cardiovascular outcomes following TAVI: Impact of pre-procedural transvalvular gradient, International Journal of Cardiology, 10.1016/j.ijcard.2012.03.066, 167:3, (687-692), Online publication date: 1-Aug-2013. Pibarot P and Dumesnil J (2012) Low-Flow, Low-Gradient Aortic Stenosis With Normal and Depressed Left Ventricular Ejection Fraction, Journal of the American College of Cardiology, 10.1016/j.jacc.2012.06.051, 60:19, (1845-1853), Online publication date: 1-Nov-2012. Gotzmann M, Lindstaedt M, Bojara W, Ewers A and Mügge A (2011) Clinical outcome of transcatheter aortic valve implantation in patients with low-flow, low gradient aortic stenosis, Catheterization and Cardiovascular Interventions, 10.1002/ccd.23240, 79:5, (693-701), Online publication date: 1-Apr-2012. Pibarot P and Dumesnil J (2011) Prosthesis-patient mismatch, Aswan Heart Centre Science & Practice Series, 10.5339/ahcsps.2011.7, 2011:1, Online publication date: 14-Apr-2011. Denault A, Deschamps A and Couture P (2010) Intraoperative Hemodynamic Instability During and After Separation From Cardiopulmonary Bypass, Seminars in Cardiothoracic and Vascular Anesthesia, 10.1177/1089253210376673, 14:3, (165-182), Online publication date: 1-Sep-2010. Pibarot P and Dumesnil J (2010) Low-Flow, Low-Gradient, Normal Ejection Fraction Aortic Stenosis, Current Cardiology Reports, 10.1007/s11886-010-0090-0, 12:2, (108-115), Online publication date: 1-Mar-2010. Suri R (2010) Effect of Prosthesis-Patient Mismatch on Long-Term Survival With Mitral Valve Replacement: Assessment to 15 Years, Yearbook of Cardiology, 10.1016/S0145-4145(09)79714-X, 2010, (205-207), Online publication date: 1-Jan-2010. Sievers H and Misfeld M (2010) Erworbene Vitien der Aortenklappe Herzchirurgie, 10.1007/978-3-540-79713-5_22, (601-634), . Kulik A, Kouchoukos N and Ruel M (2009) Avoiding Prosthesis-Patient Mismatch in the Elderly: Options Other Than Mechanical Prostheses, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2009.01.013, 88:3, (1049-1050), Online publication date: 1-Sep-2009. Mohty D, Dumesnil J, Echahidi N, Mathieu P, Dagenais F, Voisine P and Pibarot P (2009) Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement, Journal of the American College of Cardiology, 10.1016/j.jacc.2008.09.022, 53:1, (39-47), Online publication date: 1-Jan-2009. Qizilbash B, Couture P and Denault A (2008) Impact of Perioperative Transesophageal Echocardiography in Aortic Valve Replacement, Seminars in Cardiothoracic and Vascular Anesthesia, 10.1177/1089253207311789, 11:4, (288-300), Online publication date: 1-Dec-2007. Pibarot P and Dumesnil J (2007) New concepts in valvular hemodynamics: Implications for diagnosis and treatment of aortic stenosis, Canadian Journal of Cardiology, 10.1016/S0828-282X(07)71009-7, 23, (40B-47B), Online publication date: 1-Oct-2007. Burwash I (2007) Low-flow, low-gradient aortic stenosis: from evaluation to treatment, Current Opinion in Cardiology, 10.1097/HCO.0b013e32801466f5, 22:2, (84-91), Online publication date: 1-Mar-2007. December 5, 2006Vol 114, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.665018 Originally publishedDecember 5, 2006 PDF download Advertisement SubjectsCardiovascular SurgeryValvular Heart Disease
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