Yonsei Med J.  2017 Sep;58(5):968-974. 10.3349/ymj.2017.58.5.968.

Effect of Patient-Prosthesis Mismatch in Aortic Position on Late-Onset Tricuspid Regurgitation and Clinical Outcomes after Double Valve Replacement

• Lee SH
• Youn YN
• Chang BC
• Joo HC
• Lee S
• Yoo KJ

• KMID: 2418932
• DOI: http://doi.org/10.3349/ymj.2017.58.5.968

Abstract

PURPOSE
Significant late-onset tricuspid regurgitation (TR) is unfortunately common after double valve replacement (DVR); however, its underlying factors remain undefined. We evaluated the effect of aortic patient-prosthesis mismatch (PPM) on late-onset TR and clinical outcomes after DVR.
MATERIALS AND METHODS
Of the 2392 consecutive patients who underwent aortic valve replacement between January 1990 and May 2014 at our institution, we retrospectively studied 462 patients who underwent DVR (excluding concomitant tricuspid valvular annuloplasty or replacement). Survival and freedom from grade >3 TR were compared between PPM (n=152) and non-PPM (n=310) groups using the Kaplan-Meier method.
RESULTS
Although the overall survival rates were similar between the two groups at 5 and 10 years (95%, 91% vs. 96%, 93%, p=0.412), grade >3 TR-free survival was significantly lower in the PPM group (98%, 91% vs. 99%, 95%, p=0.014). Small body-surface area, atrial fibrillation, PPM, and subaortic pannus were risk factors for TR progression. However, aortic prosthesis size and trans-valvular pressure gradient were not significant factors for either TR progression or overall survival.
CONCLUSION
Aortic PPM in DVR, regardless of mitral prosthesis size, was associated with late TR progression, but was not significantly correlated with overall survival. Therefore, we recommend careful echocardiographic follow-up for the early detection of TR progression in patients with aortic PPM in DVR.

Keyword

Heart valve prosthesis implantation; double valve replacement; tricuspid valve regurgitation; patient-prosthesis mismatch

MeSH Terms

Age of Onset
Aortic Valve/diagnostic imaging/*surgery
Disease-Free Survival
Echocardiography
Female
*Heart Valve Prosthesis
*Heart Valve Prosthesis Implantation/adverse effects/mortality
Humans
Male
Middle Aged
Proportional Hazards Models
ROC Curve
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome
Tricuspid Valve Insufficiency/diagnostic imaging/mortality/*surgery

Figure

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  Fig. 1 ROC curve of aortic prosthesis size analysis to obtain the cutoff size value for inducing PPM. IEOA, indexed effective orifice area; TR, tricuspid regurgitation; ROC, receiver operating characteristic; PPM, patientprosthesis mismatch.

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  Fig. 2 PPM incidence according to aortic prosthesis size. PPM, patientprosthesis mismatch; IEOA, indexed effective orifice area.

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  Fig. 3 Overall cumulative survival rates for PPM and non-PPM groups. PPM, patient-prosthesis mismatch.

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  Fig. 4 TR-progression-free survival rates for PPM and non-PPM groups. TR, tricuspid regurgitation; PPM, patient-prosthesis mismatch.

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