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

 Seung Hyun Lee  ;  Young-Nam Youn  ;  Byung Chul Chang  ;  Hyun Chel Joo  ;  Sak Lee  ;  Kyung-Jong Yoo 
 YONSEI MEDICAL JOURNAL, Vol.58(5) : 968-974, 2017 
Journal Title
Issue Date
Age of Onset ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery* ; Disease-Free Survival ; Echocardiography ; Female ; Heart Valve Prosthesis* ; Heart Valve Prosthesis Implantation*/adverse effects ; Heart Valve Prosthesis Implantation*/mortality ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; ROC Curve ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Outcome ; Tricuspid Valve Insufficiency/diagnostic imaging ; Tricuspid Valve Insufficiency/mortality ; Tricuspid Valve Insufficiency/surgery*
Heart valve prosthesis implantation ; double valve replacement ; patient-prosthesis mismatch ; tricuspid valve regurgitation
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.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Lee, Seung Hyun(이승현) ORCID logo https://orcid.org/0000-0002-0311-6565
Chang, Byung Chul(장병철)
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
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