Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Patient Population
2.3. Definitions
2.4. Propensity Matching
2.5. Objectives
2.6. Statistical Analysis
3. Results
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Variable | All Patients | Matched Cohort | ||||
---|---|---|---|---|---|---|
Valve ≤ 19 (n = 132) | Valve ≥ 21 (n = 538) | p Value | Valve ≤ 19 (n = 126) | Valve ≥ 21 (n = 126) | p Value | |
n (%) | n (%) | n (%) | n (%) | |||
Age | 64.55 ± 11.08 | 64.82 ± 12.45 | 0.54 | 64.39 ± 11.20 | 64.5 ± 13.95 | 0.94 |
Female sex | 109 (82.59) | 311 (57.81) | <0.01 | 103 (81.75) | 107 (84.92) | 0.49 |
EuroSCORE II | 2.67 ± 3.16 | 2.11 ± 1.80 | <0.01 | 2.54 ± 3.07 | 2.59 ± 2.10 | 0.87 |
Aortic stenosis | 121 (91.67) | 510 (94.80) | 0.16 | 115 (91.27) | 116 (92.06) | 0.82 |
Arterial hypertension | 89 (67.42) | 340 (63.20) | 0.36 | 84 (66.67) | 88 (69.84) | 0.58 |
Severe pulmonary hypertension | 14 (10.61) | 46 (8.55) | 0.45 | 14 (11.11) | 15 (11.90) | 0.84 |
Diabetes | 22 (16.67) | 102 (18.96) | 0.54 | 20 (15.87) | 23 (18.25) | 0.61 |
CAD 1 | 24 (18.18) | 61 (11.34) | 0.03 | 20 (15.87) | 24 (19.05) | 0.5 |
COPD 2 | 2 (1.52) | 22 (4.09) | 0.15 | 2 (1.59) | 2 (1.59) | 1.00 |
Dyslipidemia | 61 (46.21) | 282 (52.42) | 0.20 | 60 (47.62) | 62 (49.21) | 0.80 |
PVD 3 | 4 (3.03) | 33 (6.13) | 0.16 | 4 (3.17) | 6 (4.76) | 0.51 |
Cerebrovascular disease | 4 (3.03) | 18 (3.35) | 0.85 | 3 (2.38) | 6 (4.76) | 0.30 |
LV-EF 4 | 52.41 ± 9.19 | 52 ± 9.60 | 0.66 | 52.82 ± 8.62 | 52.92 ± 10.30 | 0.93 |
Moderate mitral regurgitation | 35 (26.32) | 65 (21.74) | 0.29 | 33 (26.19) | 37 (29.37) | 0.57 |
Moderate tricuspid regurgitation | 9 (6.82) | 21 (3.90) | 0.14 | 9 (7.14) | 7 (5.56) | 0.60 |
BSA 5 | 1.71 ± 0.19 | 1.80 ± 0.19 | <0.01 | 1.71 ± 0.19 | 1.71 ± 0.20 | 0.91 |
Mean aortic gradient | 55.78 ± 21.06 | 54.14 ± 19.01 | 0.39 | 55.61 ± 21.46 | 52.72 ± 18.91 | 0.26 |
BMI 6 | 26.05 ± 4.62 | 26.97 ± 4.89 | 0.04 | 26.06 ± 4.51 | 26.15 ± 5.33 | 0.88 |
Valve Type | All Patients | Matched Cohort | ||
---|---|---|---|---|
n | % | n | % | |
Mechanic | ||||
Sorin Carbomedics TopHat | 121 | 18.05 | 43 | 17.06 |
St Jude Masters | 113 | 16.86 | 45 | 17.86 |
Carbomedics Orbis Model 100 | 43 | 6.41 | 19 | 7.54 |
Medtronic Open Pivot | 37 | 5.52 | 15 | 5.95 |
Sorin Bicarbon | 34 | 5.07 | 16 | 6.35 |
St Jude Regent | 30 | 4.48 | 9 | 3.57 |
Carbomedics Standard | 15 | 2.24 | 9 | 3.57 |
Medtronic Hall | 11 | 1.64 | 2 | 0.79 |
Sorin Allcarbon | 5 | 0.75 | 3 | 1.19 |
Medtronic Advantage | 4 | 0.6 | 0 | 0 |
ON-X | 2 | 0.3 | 0 | 0 |
St Jude HP | 1 | 0.15 | 1 | 0.4 |
Biologic | ||||
Edwards Perimount 2900 | 113 | 16.87 | 41 | 16.27 |
Medtronic Hancock II | 74 | 11.05 | 22 | 8.73 |
St Jude Epic | 29 | 4.33 | 13 | 5.16 |
Braile FABP | 17 | 2.54 | 7 | 2.78 |
Sorin Mitroflow | 7 | 1.04 | 1 | 0.4 |
Medtronic Freestyle | 6 | 0.9 | 4 | 1.59 |
Sulzer Carbomedics Labcor | 5 | 0.75 | 1 | 0.4 |
St Jude Trifecta | 2 | 0.3 | 1 | 0.4 |
Sorin Pericarbon | 1 | 0.15 | 0 | 0 |
Total | 670 | 100 | 252 | 100 |
Variable | Valve ≤ 19 n (%) | Valve ≥ 21 n (%) | p |
---|---|---|---|
Concomitant procedures | 15.08% | 11.9% | 0.46 |
CABG | 9 (7.14) | 8 (6.35) | 0.80 |
Mitral valve replacement | 7 (5.56) | 2 (1.59) | 0.09 |
Mitral valve repair | 1 (0.79) | 3 (2.59) | 0.27 |
Aortic annulus enlargement | 2 (1.58) | 1 (0.79) | 0.56 |
Ascending aortic replacement | 0 (0) | 1 (0.79) | 0.31 |
Carotid endarterectomy | 1 (0.85) | 0 (0) | 0.33 |
Operative data | |||
Bypass time (mean ± SD) | 120.23 ± 88.17 | 102.73 ± 38.35 | 0.04 |
Cross-clamp time (mean ± SD) | 77.73 ± 43.43 | 66.72 ± 16.71 | <0.01 |
Postoperative length of stay (mean ± SD) | 12.08 ± 25.20 | 9.22 ± 4.79 | 0.21 |
Early mortality (<30 days) | 5 (3.97) | 7 (5.56) | 0.55 |
EOAi (cm2/m2) | 0.67 ± 0.13 | 0.84 ± 0.20 | <0.01 |
PPM | 110 (87.30) | 73 (57.94) | <0.01 |
Severe PPM | 68 (53.97) | 18 (14.29) | <0.01 |
EuroSCORE II risk score | 2.54 ± 3.07 | 2.59 ± 2.10 | 0.87 |
Follow-up (years) (mean ± SD) | 6.54 ± 4.60 | 5.98 ± 4.47 | 0.32 |
Variable | All Patients (n = 670) | Matched Cohort (n = 252) | ||
---|---|---|---|---|
HR (95% CI) | p Value | HR (95% CI) | p Value | |
Valve size | 0.92 (0.62–1.35) | 0.68 | 0.76 (0.49–1.17) | 0.22 |
PPM | 1.06 (0.76–1.48) | 0.72 | 1.56 (0.95–2.54) | 0.07 |
Male sex | 0.84 (0.62–1.16) | 0.30 | ||
Age (per year) | 1.04 (1.03–1.06) | <0.01 | ||
Arterial hypertension | 0.92 (0.67–1.28) | 0.65 | ||
Bypass time (per min) | 1.005 (1.003–1.008) | <0.01 | ||
Dyslipidemia | 0.77 (0.56–1.06) | 0.11 | ||
Creatinine (per mg%) | 1.30 (1.13–1.50) | <0.01 | ||
CAD 1 | 1.25 (0.83–1.88) | 0.27 | ||
Ejection fraction | 0.98 (0.97–0.99) | 0.04 | ||
COPD 2 | 0.73 (0.31–1.70) | 0.47 | ||
Diabetes | 1.63 (1.14–2.52) | <0.01 | ||
BMI | 0.97 (0.99–1.01) | 0.17 | ||
PVD 3 | 1.94 (1.16–3.25) | 0.01 | ||
Cerebrovascular disease | 1.70 (0.82–3.53) | 0.14 |
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Feier, H.; Grigorescu, A.; Falnita, L.; Rachita, O.; Gaspar, M.; Luca, C.T. Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis. J. Clin. Med. 2021, 10, 2055. https://doi.org/10.3390/jcm10102055
Feier H, Grigorescu A, Falnita L, Rachita O, Gaspar M, Luca CT. Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis. Journal of Clinical Medicine. 2021; 10(10):2055. https://doi.org/10.3390/jcm10102055
Chicago/Turabian StyleFeier, Horea, Andrei Grigorescu, Lucian Falnita, Oana Rachita, Marian Gaspar, and Constantin T. Luca. 2021. "Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis" Journal of Clinical Medicine 10, no. 10: 2055. https://doi.org/10.3390/jcm10102055