Eur J Cardiothorac Surg 2002;21:769-770
© 2002 Elsevier Science NL
Changes in the current approach do not qualify prosthesis–patient mismatch either (reply to Dumesnil et al., EJCTS 2002;21:157–158)
Igor Kneza,b*,
Paul R. Vogta,
Peter Rehakc,
Bruno Riglerb
a Clinic for Cardiac, Pediatric Cardiac and Vascular Surgery, Justus Liebig University of Gießen, Rudolf Buchheim Strasse 7, D-35385 Giessen, Germany
b Division of Cardiac Surgery, Karl Franzens University and Medical School, Auenbruggerplatz 29, A-8036 Graz, Austria
c Division of Biomedical Engeneering and Computing, Karl Franzens University and Medical School, Auenbruggerplatz 29, A-8036 Graz, Austria
received in revised form 22 January 2002;
accepted 28 January 2002.
* Corresponding author. Tel.: +49-641-9944-321; fax: +49-641-9944-329
e-mail: igor_knezdr{at}yahoo.de
It was a great privilege for the authors [1] to receive an instant response from Jean Dumesnil and Phillipe Pibarot, whom the authors would like to thank for both their pioneering work and kind comments.
Our group was not the first one to emphasize valve area index (VAI) in the problem of prosthesis–patient mismatch [2]. The actual report presented the ‘phase I’ results assuming that valve prosthesis–patient mismatch might be rather negligible with the use of modern small-sized bileaflet aortic prostheses [3]. In our statistical model, neither geometric (GOA) nor effective orifice area (EOA) played a significant role. This certainly was an interesting finding. Although it was proposed, both GOA and EOA did not improve our results. By contrast, it decreased predictive values as shown in Tables 1 and 2.
In addition, the use of both variables in the very first version of our text [1] was criticized by the statistical reviewer proving the assignation of our patients significant and comprehensible. Nevertheless, we accept that patients' body surface area (BSA) evolved as a distinct parameter in our model [1]. Definitively, we did not aim to predict the absolute dimensions of left ventricular myocardial mass regression, but to filter patients with a rather ‘poor’ outcome.
Further, testing of our predictive formula (in press) in ‘phase II’ for a greater cohort of patients receiving various mechanical prostheses showed excellent results (93%). Yet, even in this case, VAI based on EOA had less influence than GOA.
Although the title of the paper might have been rather provocative, data turned out to be what they were and not what they should have been.
References
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Knez I., Rienmüller R., Maier R., Rehak P., Schröttner B., Mächler H., Anelli-Monti M., Rigler B. Left ventricular architecture after valve replacement due to critical aortic stenosis: an approach to dis-/qualify the myth of valve prosthesis-patient mismatch?. Eur J Cardiothorac Surg 2001;19(6):797-805.[Abstract/Free Full Text]
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Fernandez J., Chen Ch., Laub G.W., Anderson W.A., Brdlik O.B., Murphy M.M., McGrath L.B. Predictive value of prosthetic valve area index for early and late clinical results after valve replacement with the St. Jude medical valve prosthesis. Circulation 1996;94(Suppl 2):109-112.
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Izzat M.B., Kadir I., Reeves B., Wilde P., Bryan A.J., Angelini G.D. Patient–prosthesis mismatch is negligible with modern small-size aortic valve prostheses. Ann Thorac Surg 1999;68:1657-1660.[Abstract/Free Full Text]
