European Journal of Cardio-Thoracic Surgery 0 (2018) 1 LETTER TO THE EDITOR postoperative TPG of the cumulative population receiving the single-size ON- Patient–prosthesis mismatch after mitral X prosthesis was similar to the population receiving a different prosthesis (with a patient-speciﬁc calibrated size). Furthermore, in the latest study, an in- valve replacement: complex enigma with crease in the size of prosthesis did not correlate with a reduced TPG. On the basis of such results, we do not support the concept that ‘unlike other risk fac- more than one solution tor for PAH, mitral PPM may be prevented through a prospective strategy during surgery’ as stated in the study by Ammannaya et al. The size of pros- Pasquale Totaro* and Stefano Pelenghi thesis is not the only determinant of postoperative performances as physio- Division of Cardiac Surgery, IRCCS Foundation Hospital San Matteo, Pavia, logical factors could be more relevant in causing a high postoperative TPG. Italy Furthermore, the increased surgical risk of inserting a bigger prosthesis, to avoid ‘potential’ mitral PPM, is not supported by the current limited evidence Received 21 February 2018; accepted 26 March 2018 of a real correlation between a smaller-sized prosthesis and clinical outcomes. Keywords: Mitral valve replacement � Patients prosthesis mismatch � Transprosthesis gradient REFERENCES We read with interest the article by Ammannaya et al.  addressing the com- plex enigma of mitral patient–prosthesis mismatch (PPM), which we addressed  Ammannaya GKK, Mishra P, Khandekar JV, Mohapatra CHR, Seth HS, in 2007 [2, 3], and we would like to add few comments. We previously showed Raut C. Effect of prosthesis patient mismatch in mitral position on pul- a key factor when dealing with mitral PPM: the estimated in vitro effective ori- monary hypertension. Eur J Cardiothorac Surg 2017;52:1168–74. ﬁce area (EOA)/effective oriﬁce area index (EOAI) of a mitral prosthesis does  Totaro P, Argano V. Patient-prosthesis mismatch after mitral valve re- not accurately predict in vivo postoperative EOA/EOAI. In small-sized biopros- placement: myth or reality? J Thorac Cardiovasc Surg 2007;134:697–701. thesis, in vivo EOA/EOAI resulted, indeed, in a signiﬁcantly higher value than  Totaro P, Argano V. Reply to Pibarot et al: patients-prosthesis mismatch those reported as reference values for the same prosthesis. Incidence of PPM after mitral valve replacement back to reality. J Thoracic Cardiovasc Surg in our study, therefore, was much lower than the estimated. The 2nd ﬁnding 2008;135:465–6. of our study was the lack of correlation between increased prosthesis size and  Li M, Dumesnil JG, Mathieu P, Pibarot P. Impact of valve prosthesis- increased EOA/EOAI. As the authors clearly state, mitral PPM was associated patients mismatch on pulmonary arterial pressure after mitral valve re- with an increased rate of persistent postoperative pulmonary hypertension [4, placement. J Am Coll Cardiol 2005;45:1034–10. 5]. Ammannaya et al. stated, however, that the reported incidence of PPM  Magne J, Mathieu P, Dumesnil JG, Tanne D, Dagenais F, Doyle D et al. varies signiﬁcantly (from 7% to 71%) according to different methods of evalu- Impact of prosthesis-patients mismatch on survival after mitral valve re- ation . For this reason, despite the fact that the persistence of pulmonary placement. Circulation 2007;115:1417–25. hypertension after MVR is surely a relevant clinical aspect, we do believe that  Cho I-J, Hong G-R, Lee SH, Chang SB-C, Shim CY, Chang H-J et al. its correlation with a smaller-sized mitral prosthesis cannot be fully supported. Prosthesis-patient mismatch after mitral valve replacement: comparison As a consequence of our previous study, we have adopted the ON-X ‘one size of different methods of effective oriﬁce area calculation. Yonsei Med J ﬁts all’ prosthesis in our practice, and we are reviewing the results. In our pre- 2016;57:328–36. liminary data on 146 patients, who underwent MVR over a 4-year period, to overcome the debate regarding the method of deﬁnition of PPM, we focused on the measurement of postoperative in vivo peak/mean transprosthesis gra- *Corresponding author. Division of Cardiac Surgery, IRCCS Foundation dient (TPG) rather than EOA/EOAI. Increased TPG is indeed considered as an Hospital San Matteo, Piazzale Golgi, 27100 Pavia, Italy. Tel: +39-3283678762; essential aspect of PPM deﬁnition, as it is the main mechanism causing the fax: +39-2-8053331; e-mail: firstname.lastname@example.org (P. Totaro). persistence of high pulmonary pressure. Overall incidence of signiﬁcantly increased TPG of our group was <10%. No correlation was found between the doi:10.1093/ejcts/ezy163 incidence of high TPG and type (or size) of prosthesis. More speciﬁcally, The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Downloaded from https://academic.oup.com/ejcts/advance-article-abstract/doi/10.1093/ejcts/ezy163/4978191 by Ed 'DeepDyve' Gillespie user on 12 July 2018 LETTER TO THE EDITOR
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Apr 19, 2018
It’s your single place to instantly
discover and read the research
that matters to you.
Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.
All for just $49/month
Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly
Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.
All the latest content is available, no embargo periods.
“Whoa! It’s like Spotify but for academic articles.”@Phil_Robichaud