title: Prevalence and long-term outcome of aortic prosthesis-patient mismatch in patients with paradoxical low-flow severe aortic stenosis.
abstract: BACKGROUND
  Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis-patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS.
  
  
  RESULTS
  Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm(2)). A PLF (indexed stroke volume ≤35 mL/m(2)) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area ≤0.85 cm(2)/m(2). The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P<0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P=0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5-4.45; P=0.0007).
  
  
  CONCLUSIONS
  In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome.
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.). dania.mohty@chu-limoges.fr.
authors.forename: Dania
authors.initials: D
authors.lastname: Mohty
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Cyrille
authors.initials: C
authors.lastname: Boulogne
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Najmeddine
authors.initials: N
authors.lastname: Echahidi
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cornu
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Jean
authors.initials: J
authors.lastname: Dumesnil
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Patrice
authors.initials: P
authors.lastname: Virot
authors.affiliation: From the CHU Limoges, Hôpital Dupuytren, Service Cardiologie (D.M., C.B., J.M., N.E., P.V., V.A.) and Service de Chirurgie thoracique et cardiovasculaire (E.C., M.L.), Limoges, France; INSERM 1094, Faculté de médecine de Limoges, Limoges, France (D.M., J.M.); and Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, Quebec, Canada (P.P., J.D.).
authors.forename: Victor
authors.initials: V
authors.lastname: Aboyans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000453:epidemiology; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D004867:Equipment Design; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality; D015995:Prevalence; D013318:Stroke Volume; D016896:Treatment Outcome
keywords: aortic valve stenosis; stroke volume