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J Cardiothorac Vasc Anesth. 2013 Aug;27(4):647-53. doi: 10.1053/j.jvca.2013.03.016.

Is patient-prosthesis mismatch a perioperative predictor of long-term mortality after aortic valve replacement?

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1
Department of Anesthesiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Abstract

OBJECTIVES:

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).

DESIGN:

A retrospective study of prospectively collected data.

SETTING:

A tertiary care university hospital.

PARTICIPANTS:

One-hundred-ninety-nine adult patients who underwent AVR.

INTERVENTIONS:

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.

MEASUREMENTS AND MAIN 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.

KEYWORDS:

aortic valve replacement; cardiopulmonary bypass; mortality; outcome; patient-prosthesis mismatch; perioperative; pulmonary hypertension

PMID:
23849521
DOI:
10.1053/j.jvca.2013.03.016
[Indexed for MEDLINE]
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