Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials

Vinod H. Thourani; Amr E. Abbas; Julien Ternacle; Rebecca T. Hahn; Raj Makkar; Susheel K. Kodali; Isaac George; Samir Kapadia; Lars G. Svensson; Wilson Y. Szeto; Howard C. Herrmann; Gorav Ailawadi; Jonathon Leipsic; Philipp Blanke; John Webb; Wael A. Jaber; Mark Russo; S. Chris Malaisrie; Pradeep Yadav; Marie Annick Clavel; Omar K. Khalique; Neil J. Weissman; Pamela Douglas; Jeroen Bax; Abdellaziz Dahou; Ke Xu; Vinayak Bapat; Maria C. Alu; Martin B. Leon; Michael J. Mack; Philippe Pibarot

doi:10.1016/j.athoracsur.2024.01.023

Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials

Vinod H. Thourani^*, Amr E. Abbas, Julien Ternacle, Rebecca T. Hahn, Raj Makkar, Susheel K. Kodali, Isaac George, Samir Kapadia, Lars G. Svensson, Wilson Y. Szeto, Howard C. Herrmann, Gorav Ailawadi, Jonathon Leipsic, Philipp Blanke, John Webb, Wael A. Jaber, Mark Russo, S. Chris Malaisrie, Pradeep Yadav, Marie Annick ClavelOmar K. Khalique, Neil J. Weissman, Pamela Douglas, Jeroen Bax, Abdellaziz Dahou, Ke Xu, Vinayak Bapat, Maria C. Alu, Martin B. Leon, Michael J. Mack, Philippe Pibarot

^*Corresponding author for this work

Surgery, Cardiac Surgery Division

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Background: Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. Methods: Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm²/m²) or severe (indexed effective orifice area ≤0.65 cm²/m²). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. Results: By the predicted PPM method (PPM_P), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPM_M), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPM_P (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPM_P (38.8%, P = .02). Using the PPM_M method, there was no difference between the no (17.7%) and moderate PPM_M groups (21.1%) in the primary outcome (P = .16). However, those with no PPM_M or moderate PPM_M were improved compared with severe PPM_M (27.4%, P < .001 and P = .02, respectively). Conclusions: Severe PPM analyzed by PPM_P was only 2.1% for surgical aortic valve replacement patients. The PPM_M method overestimated the incidence of severe PPM relative to PPM_P, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.

Original language	English (US)
Pages (from-to)	1164-1171
Number of pages	8
Journal	Annals of Thoracic Surgery
Volume	117
Issue number	6
DOIs	https://doi.org/10.1016/j.athoracsur.2024.01.023
State	Published - Jun 2024

Funding

The PARTNER Trials were funded by Edwards Lifesciences .

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

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10.1016/j.athoracsur.2024.01.023

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Thourani, V. H., Abbas, A. E., Ternacle, J., Hahn, R. T., Makkar, R., Kodali, S. K., George, I., Kapadia, S., Svensson, L. G., Szeto, W. Y., Herrmann, H. C., Ailawadi, G., Leipsic, J., Blanke, P., Webb, J., Jaber, W. A., Russo, M., Malaisrie, S. C., Yadav, P., ... Pibarot, P. (2024). Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials. Annals of Thoracic Surgery, 117(6), 1164-1171. https://doi.org/10.1016/j.athoracsur.2024.01.023

@article{a10baabb342a474680609f59a1fcf6dc,

title = "Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials",

abstract = "Background: Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. Methods: Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. Results: By the predicted PPM method (PPMP), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPMM), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPMP (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPMP (38.8%, P = .02). Using the PPMM method, there was no difference between the no (17.7%) and moderate PPMM groups (21.1%) in the primary outcome (P = .16). However, those with no PPMM or moderate PPMM were improved compared with severe PPMM (27.4%, P < .001 and P = .02, respectively). Conclusions: Severe PPM analyzed by PPMP was only 2.1% for surgical aortic valve replacement patients. The PPMM method overestimated the incidence of severe PPM relative to PPMP, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.",

author = "Thourani, {Vinod H.} and Abbas, {Amr E.} and Julien Ternacle and Hahn, {Rebecca T.} and Raj Makkar and Kodali, {Susheel K.} and Isaac George and Samir Kapadia and Svensson, {Lars G.} and Szeto, {Wilson Y.} and Herrmann, {Howard C.} and Gorav Ailawadi and Jonathon Leipsic and Philipp Blanke and John Webb and Jaber, {Wael A.} and Mark Russo and Malaisrie, {S. Chris} and Pradeep Yadav and Clavel, {Marie Annick} and Khalique, {Omar K.} and Weissman, {Neil J.} and Pamela Douglas and Jeroen Bax and Abdellaziz Dahou and Ke Xu and Vinayak Bapat and Alu, {Maria C.} and Leon, {Martin B.} and Mack, {Michael J.} and Philippe Pibarot",

note = "Publisher Copyright: {\textcopyright} 2024 The Society of Thoracic Surgeons",

year = "2024",

month = jun,

doi = "10.1016/j.athoracsur.2024.01.023",

language = "English (US)",

volume = "117",

pages = "1164--1171",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier Inc.",

number = "6",

}

Thourani, VH, Abbas, AE, Ternacle, J, Hahn, RT, Makkar, R, Kodali, SK, George, I, Kapadia, S, Svensson, LG, Szeto, WY, Herrmann, HC, Ailawadi, G, Leipsic, J, Blanke, P, Webb, J, Jaber, WA, Russo, M, Malaisrie, SC, Yadav, P, Clavel, MA, Khalique, OK, Weissman, NJ, Douglas, P, Bax, J, Dahou, A, Xu, K, Bapat, V, Alu, MC, Leon, MB, Mack, MJ & Pibarot, P 2024, 'Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials', Annals of Thoracic Surgery, vol. 117, no. 6, pp. 1164-1171. https://doi.org/10.1016/j.athoracsur.2024.01.023

TY - JOUR

T1 - Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement

T2 - Analysis of the PARTNER Trials

AU - Thourani, Vinod H.

AU - Abbas, Amr E.

AU - Ternacle, Julien

AU - Hahn, Rebecca T.

AU - Makkar, Raj

AU - Kodali, Susheel K.

AU - George, Isaac

AU - Kapadia, Samir

AU - Svensson, Lars G.

AU - Szeto, Wilson Y.

AU - Herrmann, Howard C.

AU - Ailawadi, Gorav

AU - Leipsic, Jonathon

AU - Blanke, Philipp

AU - Webb, John

AU - Jaber, Wael A.

AU - Russo, Mark

AU - Malaisrie, S. Chris

AU - Yadav, Pradeep

AU - Clavel, Marie Annick

AU - Khalique, Omar K.

AU - Weissman, Neil J.

AU - Douglas, Pamela

AU - Bax, Jeroen

AU - Dahou, Abdellaziz

AU - Xu, Ke

AU - Bapat, Vinayak

AU - Alu, Maria C.

AU - Leon, Martin B.

AU - Mack, Michael J.

AU - Pibarot, Philippe

PY - 2024/6

Y1 - 2024/6

N2 - Background: Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. Methods: Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. Results: By the predicted PPM method (PPMP), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPMM), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPMP (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPMP (38.8%, P = .02). Using the PPMM method, there was no difference between the no (17.7%) and moderate PPMM groups (21.1%) in the primary outcome (P = .16). However, those with no PPMM or moderate PPMM were improved compared with severe PPMM (27.4%, P < .001 and P = .02, respectively). Conclusions: Severe PPM analyzed by PPMP was only 2.1% for surgical aortic valve replacement patients. The PPMM method overestimated the incidence of severe PPM relative to PPMP, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.

AB - Background: Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. Methods: Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. Results: By the predicted PPM method (PPMP), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPMM), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPMP (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPMP (38.8%, P = .02). Using the PPMM method, there was no difference between the no (17.7%) and moderate PPMM groups (21.1%) in the primary outcome (P = .16). However, those with no PPMM or moderate PPMM were improved compared with severe PPMM (27.4%, P < .001 and P = .02, respectively). Conclusions: Severe PPM analyzed by PPMP was only 2.1% for surgical aortic valve replacement patients. The PPMM method overestimated the incidence of severe PPM relative to PPMP, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.

UR - http://www.scopus.com/inward/record.url?scp=85186605151&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85186605151&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2024.01.023

DO - 10.1016/j.athoracsur.2024.01.023

M3 - Article

C2 - 38316377

AN - SCOPUS:85186605151

SN - 0003-4975

VL - 117

SP - 1164

EP - 1171

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

IS - 6

ER -

Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials

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