Impact of aortic stenosis severity and its interaction with prosthesis-patient mismatch on operative mortality following aortic valve replacement.
OBJECTIVE
The optimal timing of aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) is a source of debate. Moreover, it has been shown previously that prosthesis-patient mismatch (PPM) is an independent predictor of operative mortality after AVR. The study aim was to assess the effect of the preoperative severity of AS and its interaction with PPM with respect to operative mortality after AVR.


METHODS
The data were analyzed from 2,104 consecutive patients who had undergone AVR for severe AS. The patients were allocated to tertiles according to their preoperative indexed aortic valve area (AVAi) as: < 0.35 cm2/m2, 0.35 to 0.43 cm2/m2, and > 0.43 cm2/m2. PPM was defined as a projected postoperative indexed effective orifice area (EOAi) of the implanted prosthesis < 0.85 cm2/m2.


RESULTS
The operative mortality was 5.7% (n = 120). On multivariate analysis, an independent association was identified between the preoperative severity of AS and operative mortality (odds ratio [OR] = 2.00, p = 0.03 for AVAi < 0.35 cm2/m2; OR = 1.39, p = 0.32 for AVAi 0.35-0.43 cm2/m2). Notably, the impact of PPM was more important in patients with more severe AS (p = 0.046 for AVAi x EOAi interaction).


CONCLUSIONS
The study results confirmed that very severe AS (AVAi < 0.35 cm2/m2) is independently associated with operative mortality after AVR. The results also emphasized the importance of avoiding PPM in these patients.
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Department of Cardiology, Laval University, Québec, Canada.
Nicolas
N
Girerd
Patrick
P
Mathieu
Jean G
JG
Dumesnil
Julien
J
Magne
Eric
E
Charbonneau
François
F
Dagenais
Eric
E
Dumont
Pierre
P
Voisine
Richard
R
Baillot
Philippe
P
Pibarot
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D012720:Severity of Illness Index