title: Can postoperative mean transprosthetic pressure gradient predict survival after aortic valve replacement?
abstract: BACKGROUND
  In this study, we sought to determine the effect of the mean transprosthetic pressure gradient (TPG), measured at 6 weeks after aortic valve replacement (AVR) or AVR with coronary artery bypass grafting (CABG) on late all-cause mortality.
  
  
  METHODS
  Between January 1998 and March 2012, 2,276 patients (mean age 68 ± 11 years) underwent TPG analysis at 6 weeks after AVR (n = 1,318) or AVR with CABG (n = 958) at a single institution. Mean TPG was 11.6 ± 7.8 mmHg and median TPG 11 mmHg. Based on the TPG, the patients were split into three groups: patients with a low TPG (<10 mmHg), patients with a medium TPG (10-19 mmHg) and patients with a high TPG (≥ 20 mmHg). Cox proportional-hazard regression analysis was used to determine univariate predictors and multivariate independent predictors of late mortality.
  
  
  RESULTS
  Overall survival for the entire group at 1, 3, 5, and 10 years was 97, 93, 87 and 67%, respectively. There was no significant difference in long-term survival between patients with a low, medium or high TPG (p = 0.258). Independent predictors of late mortality included age, diabetes, peripheral vascular disease, renal dysfunction, chronic obstructive pulmonary disease, a history of a cerebrovascular accident and cardiopulmonary bypass time. Prosthesis-patient mismatch (PPM), severe PPM and TPG measured at 6 weeks postoperatively were not significantly associated with late mortality.
  
  
  CONCLUSIONS
  TPG measured at 6 weeks after AVR or AVR with CABG is not an independent predictor of all-cause late mortality and there is no significant difference in long-term survival between patients with a low, medium or high TPG.
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA, Eindhoven, The Netherlands, b.m.j.a.koene@umcg.nl.
authors.forename: Bart M
authors.initials: BM
authors.lastname: Koene
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Soliman Hamad
authors.forename: Wobbe
authors.initials: W
authors.lastname: Bouma
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Mariani
authors.forename: Kathinka C
authors.initials: KC
authors.lastname: Peels
authors.forename: Jan-Melle
authors.initials: JM
authors.lastname: van Dantzig
authors.forename: Albert H
authors.initials: AH
authors.lastname: van Straten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome