6 research outputs found
Surgical aortic valve replacement and patient-prosthesis mismatch a meta-analysis of 108 182 patients
OBJECTIVES: This study sought to evaluate the impact of patient–prosthesis mismatch (PPM) on the risk of perioperative, early-, mid- and long-term mortality rates after surgical aortic valve replacement.
METHODS: Databases were searched for studies published until March 2018. The main outcomes of interest were perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality.
RESULTS: The search yielded 3761 studies for inclusion. Of these, 70 articles were analysed, and their data were extracted. The total num- ber of patients included was 108 182 who underwent surgical aortic valve replacement. The incidence of PPM after surgical aortic valve re- placement was 53.7% (58 116 with PPM and 50 066 without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95% confidence interval
(CI) 1.302–1.707; P < 0.001], 1-year mortality (OR 1.465, 95% CI 1.277–1.681; P < 0.001), 5-year mortality (OR 1.358, 95% CI 1.218–1.515;
P < 0.001) and 10-year mortality (OR 1.534, 95% CI 1.290–1.825; P < 0.001) were increased in patients with PPM. Both severe PPM and moderate PPM were associated with increased risk of perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality when analysed together and separately, although we observed a higher risk in the group with severe PPM.
CONCLUSIONS: Moderate/severe PPM increases perioperative, early-, mid- and long-term mortality rates proportionally to its severity. The findings of this study support the implementation of surgical strategies to prevent PPM in order to decrease mortality rates
A APNEIA OBSTRUTIVA DO SONO ESTÁ ASSOCIADA COM MAIOR MORBIDADE E MORTALIDADE CARDIOVASCULAR EM PACIENTES COM EDEMA AGUDO DOS PULMÕES CARDIOGÊNICO
Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement : a meta-analysis of 13 174 patients
OBJECTIVES: This study sought to evaluate the impact of surgical aortic root enlargement (ARE) on the perioperative outcomes of aortic valve replacement (AVR).
METHODS: Databases were searched for studies published until April 2018 to carry out a systematic review followed by meta-analysis of results.
RESULTS: The search yielded 1468 studies for inclusion. Of these, 10 articles were analysed and their data extracted. A total of 13 174 patients (AVR with ARE: 2819 patients; AVR without ARE: 10 355 patients) were included from studies published from 2002 to 2018. The
total rate of ARE was 21.4%, varying in the studies from 5.7% to 26.3%. The overall odds ratio (OR) [95% confidence interval (CI)] for periop- erative mortality showed a statistically significant difference between the groups (among 10 studies), with a higher risk in the ‘AVR with ARE’ group (OR 1.506, 95% CI 1.209–1.875; P < 0.001), but not when adjusted for isolated AVR + ARE without any concomitant procedures such as mitral valve surgery, coronary artery bypass surgery, etc. (OR 1.625, 95% CI 0.968–2.726; P = 0.066—among 6 studies). The ‘AVR with ARE’ group showed an overall lower risk of significant patient–prosthesis mismatch among 9 studies (OR 0.472, 95% CI 0.295–0.756; P = 0.002) and a higher overall difference in means of indexed effective orifice area among 10 studies (random-effect model: 0.06 cm2/m2, 95% CI 0.029–0.103; P < 0.001).
CONCLUSIONS: Surgical ARE seems to be associated with increased perioperative mortality but with lower risk of patient–prosthesis mismatch