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Predictors and Outcomes of Prosthesis-Patient Mismatch After Trifecta Bioprosthetic Aortic Valve Replacement
Session:
SESSÃO DE POSTERS 54 - INTERVENÇÃO MITRAL PERCUTÂNEA E CIRURGIA CARDÍACA
Speaker:
Rui Cerqueira
Congress:
CPC 2025
Topic:
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Theme:
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Subtheme:
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Session Type:
Cartazes
FP Number:
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Authors:
Rui Cerqueira; Inês Sousa; Cândida Gonçalves; Soraia Moreira; Pedro Palma; Mário Jorge Amorim; Paulo Pinho; Sílvia Diaz; António Barros; André Lourenço; Francisca Saraiva; Adelino Leite-Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Introduction:</span></strong><span style="font-family:"Calibri",sans-serif"> Severe prothesis-patient mismatch (PPM) has been associated with higher risk of late mortality and incidence of structural valve deterioration (SVD). However, data on this matter is sparse and more clarifying results are need.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Aims: </span></strong><span style="font-family:"Calibri",sans-serif">To assess the long-term mortality and reintervention due to SVD related to PPM after surgical aortic valve replacement (AVR) with Trifecta bioprosthesis (TF).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Methods:</span></strong><span style="font-family:"Calibri",sans-serif"> Single-center, longitudinal study, consecutive patients who underwent surgical AVR with TF between July 2011 and December 2019 with available data from post-operative transthoracic echocardiogram (TTE) were enrolled. Moderate PPM was characterized by an aortic valve effective orifice area indexed (EOAi) between 0.84-0.65 cm<sup>2</sup>/m<sup>2</sup>, while severe PPM was defined by an EOAi<0.65cm<sup>2</sup>/m<sup>2</sup> based on the TTE performed (median of 4 months post-operatively). Multivariable logistic regression analysis was employed to assess the covariates influencing PPM. Time-to-event outcomes were studied using Kaplan-Meier Curves, Log-Rank test and multivariable Cox Regression. Median follow-up was 6 years, maximum 12 years.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Results:</span></strong><span style="font-family:"Calibri",sans-serif"> We included 974 patients, 54% being men and 8% exhibiting PPM: 7% moderate and 1% severe. The cohort was divided into PPM group (joining moderate and severe cases, n=80) and Free-PPM group (n=894). Most of the cardiovascular risk factors were comparable between groups, except for diabetes mellitus which was higher in the PPM group (50% vs. 33%, p=0.003). The mean European System for Cardiac Operative Risk Evaluation (Euroscore II) was similar between groups (PPM 3.4±3.1% vs. Free-PPM 3.8±4.6%, p=0.859) and the body surface area (BSA) was higher in the PPM group (1.82±0.18m<sup>2</sup> vs. 1.76±0.17m<sup>2</sup>, p=0.007)..Multivariable logistic regression identified diabetes mellitus (OR[95%CI]: 2.00 [1.25-3.18], p=0.003) and women (OR[95%CI]: 1.75 [1.06-2.86], p=0.027) as significant predictive factors for PPM. At 1-, 5- and 10- years of follow-up, cumulative survival for Free-PPM vs. PPM were 98% vs. 96%, 80% vs. 74% and 59% vs. 40%, respectively, Log-Rank test p=0.044. Multivariable adjustment showed that PPM patients had a higher risk of all-causes mortality (HR[95%CI]: 1.48 [1.03-2.14], p=0.035), adjusted for EuroSCORE II. Reintervention due to SVD was similar between groups (HR[95%CI]: 0.49[0.21-1.17], p=0.11).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusion:</span></strong><span style="font-family:"Calibri",sans-serif"> PPM was linked to poorer survival outcomes compared to patients without PPM. Women and individuals with diabetes mellitus appear to face a higher risk of experiencing PPM. These results underscore the significance of conducting a thorough pre-operative evaluation to select appropriate prosthesis sizes for each patient.</span></span></span></p>
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