TY - JOUR
T1 - Aortic valve prosthesis-patient mismatch and exercise capacity in adult patients with congenital heart disease
AU - Van Slooten, Ymkje J.
AU - Van Melle, Joost P.
AU - Freling, Hendrik G.
AU - Bouma, Berto J.
AU - Van Dijk, Arie P.J.
AU - Jongbloed, Monique R.M.
AU - Post, Martijn C.
AU - Sieswerda, Gertjan T.
AU - Huis In'T Veld, Anna
AU - Ebels, Tjark
AU - Voors, Adriaan A.
AU - Pieper, Petronella G.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Objectives: To report the prevalence of aortic valve prosthesis-patient mismatch (PPM) in an adult population with congenital heart disease (CHD) and its impact on exercise capacity. Adults with congenital heart disease (ACHD) with a history of aortic valve replacement may outgrow their prosthesis later in life. However, the prevalence and clinical consequences of aortic PPM in ACHD are presently unknown. Methods: From the national Dutch Congenital Corvitia (CONCOR) registry, we identified 207 ACHD with an aortic valve prosthesis for this cross-sectional cohort study. Severe PPM was defined as an indexed effective orifice area ≥0.65 cm2/m2 and moderate PPM as an indexed orifice area ≥0.85 cm2/m2 measured using echocardiography. Exercise capacity was reported as percentage of predicted exercise capacity (PPEC). Results: Of the 207 patients, 68% was male, 71% had a mechanical prosthesis and mean age at inclusion was 43.9 years ±11.4. The prevalence of PPM was 42%, comprising 23% severe PPM and 19% moderate PPM. Prevalence of PPM was higher in patients with mechanical prostheses (p<0.001). PPM was associated with poorer exercise capacity (mean PPEC 84% vs 92%; p=0.048, mean difference =-8.3%, p=0.047). Mean follow-up was 2.6±1.1 years during which New York Heart Association (NYHA) class remained stable in most patients. PPM showed no significant effect on death or hospitalisation during follow-up (p=0.218). Conclusions: In this study we report a high prevalence (42%) of PPM in ACHD with an aortic valve prosthesis and an independent association of PPM with diminished exercise capacity.
AB - Objectives: To report the prevalence of aortic valve prosthesis-patient mismatch (PPM) in an adult population with congenital heart disease (CHD) and its impact on exercise capacity. Adults with congenital heart disease (ACHD) with a history of aortic valve replacement may outgrow their prosthesis later in life. However, the prevalence and clinical consequences of aortic PPM in ACHD are presently unknown. Methods: From the national Dutch Congenital Corvitia (CONCOR) registry, we identified 207 ACHD with an aortic valve prosthesis for this cross-sectional cohort study. Severe PPM was defined as an indexed effective orifice area ≥0.65 cm2/m2 and moderate PPM as an indexed orifice area ≥0.85 cm2/m2 measured using echocardiography. Exercise capacity was reported as percentage of predicted exercise capacity (PPEC). Results: Of the 207 patients, 68% was male, 71% had a mechanical prosthesis and mean age at inclusion was 43.9 years ±11.4. The prevalence of PPM was 42%, comprising 23% severe PPM and 19% moderate PPM. Prevalence of PPM was higher in patients with mechanical prostheses (p<0.001). PPM was associated with poorer exercise capacity (mean PPEC 84% vs 92%; p=0.048, mean difference =-8.3%, p=0.047). Mean follow-up was 2.6±1.1 years during which New York Heart Association (NYHA) class remained stable in most patients. PPM showed no significant effect on death or hospitalisation during follow-up (p=0.218). Conclusions: In this study we report a high prevalence (42%) of PPM in ACHD with an aortic valve prosthesis and an independent association of PPM with diminished exercise capacity.
UR - http://www.scopus.com/inward/record.url?scp=84958974871&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2015-308013
DO - 10.1136/heartjnl-2015-308013
M3 - Article
C2 - 26596791
AN - SCOPUS:84958974871
SN - 1355-6037
VL - 102
SP - 107
EP - 113
JO - Heart
JF - Heart
IS - 2
ER -