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Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement.

Publication ,  Journal Article
Bridges, CR; O'Brien, SM; Cleveland, JC; Savage, EB; Gammie, JS; Edwards, FH; Peterson, ED; Grover, FL
Published in: J Thorac Cardiovasc Surg
April 2007

OBJECTIVES: The appropriate index of prosthesis internal orifice size and its effect on operative mortality after aortic valve replacement are controversial. We examined the association between several relevant indices and patient size on operative mortality. Indices examined included projected in vivo effective orifice area and geometric orifice area, with patient size defined as body surface area. METHODS: A review of the Society of Thoracic Surgeons National Cardiac Database (2000-2004) yielded 48,722 patients who had isolated aortic valve replacement. This analysis is based on the cohort of 42,310 patients with the 8 most prevalent valve types with manufacturer's labeled sizes 19 mm through 29 mm. Multivariable logistic regression models were employed to determine the effects of body surface area, effective orifice area, geometric orifice area, and selected derived indices (eg, effective orifice area/body surface area) on risk-adjusted operative mortality. RESULTS: In separate multivariable models, effective orifice area and geometric orifice area were both inversely correlated with operative mortality. However, an unanticipated finding was that with either effective orifice area or geometric orifice area held constant, body surface area was significantly and inversely correlated with operative mortality. When patients were stratified by effective orifice area, geometric orifice area, or manufacturer's labeled valve size and type, elevations in body surface area were associated with a decrease rather than an increase in operative mortality. CONCLUSIONS: Prostheses with small geometric orifice area or small effective orifice area are associated with increased operative mortality after isolated aortic valve replacement. Even for valves with small effective orifice area, however, mortality decreases as body surface area increases. With respect to operative mortality, therefore, our results do not support using arbitrary cutoff values of effective orifice area/body surface area to determine the valve to utilize in a given patient.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

April 2007

Volume

133

Issue

4

Start / End Page

1012 / 1021

Location

United States

Related Subject Headings

  • Respiratory System
  • Prosthesis Design
  • Middle Aged
  • Male
  • Humans
  • Heart Valve Prosthesis Implantation
  • Heart Valve Prosthesis
  • Heart Valve Diseases
  • Female
  • Body Surface Area
 

Citation

APA
Chicago
ICMJE
MLA
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Bridges, C. R., O’Brien, S. M., Cleveland, J. C., Savage, E. B., Gammie, J. S., Edwards, F. H., … Grover, F. L. (2007). Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement. J Thorac Cardiovasc Surg, 133(4), 1012–1021. https://doi.org/10.1016/j.jtcvs.2006.11.028
Bridges, Charles R., Sean M. O’Brien, Joseph C. Cleveland, Edward B. Savage, James S. Gammie, Fred H. Edwards, Eric D. Peterson, and Frederick L. Grover. “Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement.J Thorac Cardiovasc Surg 133, no. 4 (April 2007): 1012–21. https://doi.org/10.1016/j.jtcvs.2006.11.028.
Bridges CR, O’Brien SM, Cleveland JC, Savage EB, Gammie JS, Edwards FH, et al. Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement. J Thorac Cardiovasc Surg. 2007 Apr;133(4):1012–21.
Bridges, Charles R., et al. “Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement.J Thorac Cardiovasc Surg, vol. 133, no. 4, Apr. 2007, pp. 1012–21. Pubmed, doi:10.1016/j.jtcvs.2006.11.028.
Bridges CR, O’Brien SM, Cleveland JC, Savage EB, Gammie JS, Edwards FH, Peterson ED, Grover FL. Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement. J Thorac Cardiovasc Surg. 2007 Apr;133(4):1012–1021.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

April 2007

Volume

133

Issue

4

Start / End Page

1012 / 1021

Location

United States

Related Subject Headings

  • Respiratory System
  • Prosthesis Design
  • Middle Aged
  • Male
  • Humans
  • Heart Valve Prosthesis Implantation
  • Heart Valve Prosthesis
  • Heart Valve Diseases
  • Female
  • Body Surface Area