title: Is patient-prosthesis mismatch a perioperative predictor of long-term mortality after aortic valve replacement?
abstract: OBJECTIVE
  To determine the perioperative predictors of long-term mortality after aortic valve replacement (AVR). The authors hypothesized that perioperative variables are more important predictors of mortality than patient-prosthesis mismatch (PPM).
  
  
  METHODS
  A retrospective study of prospectively collected data.
  
  
  METHODS
  A tertiary care university hospital.
  
  
  METHODS
  One-hundred-ninety-nine adult patients who underwent AVR.
  
  
  METHODS
  After Research and Ethics Committee approval, the authors studied consecutive adult patients that underwent AVR in 1999 from the time of procedure to 5 years later. Demographic data, hemodynamic profile obtained after the induction of anesthesia, and perioperative data were analyzed. Primary endpoint was 5-year survival.
  
  
  RESULTS
  Actuarial survival rate was 95.98%, 91.46%, and 81.91% at 30 days, 1 year, and 5 years, respectively. On univariate analysis, patients who died were significantly older (p<0.0001), had pulmonary hypertension (PHT), longer cardiopulmonary bypass (CPB) (p = 0.0001) and cross-clamping duration (p = 0.003), more frequent return to CPB (p = 0.036), or the use of an intra-aortic balloon pump to wean from CPB (p = 0.015). PPM was not related to 5-year mortality (p = 0.0649). Using Cox survival analysis, the only independent risk factors related to 5-year mortality after AVR were PHT using the mean arterial pressure-to-mean pulmonary artery pressure ratio (HR: 1.39, 95% CI 1.01-1.92, p = 0.0413) and the presence of complex separation from CPB (HR: 2.66, 95% CI 1.08-6.50, p = 0.0324).
  
  
  CONCLUSIONS
  In patients undergoing AVR, 5-year survival was mostly related to the severity of PHT and intraoperative factors, mainly complexity of weaning from CPB.
authors.affiliation: Department of Anesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Bianco
authors.forename: Baqir
authors.initials: B
authors.lastname: Qizilbash
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.forename: Annik
authors.initials: A
authors.lastname: Fortier
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
mesh_terms: D000206:Actuarial Analysis; D000367:Age Factors; D000368:Aged; D000768:Anesthesia, General; D001021:Aortic Valve / Q000601:surgery*; D002407:Catheterization, Swan-Ganz; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis; D013815:Thermodilution; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents
keywords: aortic valve replacement; cardiopulmonary bypass; mortality; outcome; patient-prosthesis mismatch; perioperative; pulmonary hypertension