title: Aortic valve prosthesis-patient mismatch and exercise capacity in adult patients with congenital heart disease.
abstract: OBJECTIVE
  To report the prevalence of aortic valve prosthesis-patient mismatch (PPM) in an adult population with congenital heart disease (CHD) and its impact on exercise capacity. Adults with congenital heart disease (ACHD) with a history of aortic valve replacement may outgrow their prosthesis later in life. However, the prevalence and clinical consequences of aortic PPM in ACHD are presently unknown.
  
  
  METHODS
  From the national Dutch Congenital Corvitia (CONCOR) registry, we identified 207 ACHD with an aortic valve prosthesis for this cross-sectional cohort study. Severe PPM was defined as an indexed effective orifice area ≤0.65 cm2/m2 and moderate PPM as an indexed orifice area ≤0.85 cm2/m2 measured using echocardiography. Exercise capacity was reported as percentage of predicted exercise capacity (PPEC).
  
  
  RESULTS
  Of the 207 patients, 68% was male, 71% had a mechanical prosthesis and mean age at inclusion was 43.9 years ±11.4. The prevalence of PPM was 42%, comprising 23% severe PPM and 19% moderate PPM. Prevalence of PPM was higher in patients with mechanical prostheses (p<0.001). PPM was associated with poorer exercise capacity (mean PPEC 84% vs. 92%; p=0.048, mean difference =-8.3%, p=0.047). Mean follow-up was 2.6±1.1 years during which New York Heart Association (NYHA) class remained stable in most patients. PPM showed no significant effect on death or hospitalisation during follow-up (p=0.218).
  
  
  CONCLUSIONS
  In this study we report a high prevalence (42%) of PPM in ACHD with an aortic valve prosthesis and an independent association of PPM with diminished exercise capacity.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Department of Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: Ymkje J
authors.initials: YJ
authors.lastname: van Slooten
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Hendrik G
authors.initials: HG
authors.lastname: Freling
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Arie Pj
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Monique Rm
authors.initials: MR
authors.lastname: Jongbloed
authors.affiliation: Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Martijn C
authors.initials: MC
authors.lastname: Post
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Gertjan T
authors.initials: GT
authors.lastname: Sieswerda
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Anna
authors.initials: A
authors.lastname: Huis In 't Veld
authors.affiliation: Department of Thoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Tjark
authors.initials: T
authors.lastname: Ebels
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D000082882:Bicuspid Aortic Valve Disease; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000592:standards; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011475:Prosthesis Failure / Q000209:etiology*; D012042:Registries; D016896:Treatment Outcome