Effects of Primary Aortic Disease on Patient-Prosthetic Valve Mismatch　– Reply –

We appreciated very much the valuable comments by Dr Gokalp and colleagues on our recent original article in Circulation Journal.¹ As pointed out by them, we totally agree that our heterogeneous patient population may have affected the long-term outcomes of the patients undergoing aortic valve replacement using mechanical valves, such as overall survival and freedom from reoperation because of prosthetic valve dysfunction. As shown in Table 1 of the original article, the aortic valve lesion consisted of aortic regurgitation (AR) in 57.3% of the patients, aortic stenosis (AS) in 15.5%, and mixed lesion (ASR) in 26.1%. The mean sizes of the valves implanted were 23.4±2.2 mm in AR patients, 21.3±2.0 mm in AS, and 21.8±1.9 mm in ASR. On the other hand, the mean values of body surface area were 1.53±0.17 m² in AR patients, 1.48±0.16 m² in AS, and 1.47±0.17 m² in ASR. In addition, the standard type of SJM valves was predominantly used in this study period; however, the Hemodynamic Plus (HP) model was also used in some patients. In fact, the use of the HP model was 5.9% in AR patients, 19.4% in AS, and 11.5% in ASR. Therefore, it is true that those patients with AR tended to have a larger size of prosthesis, while those with AS, who had relatively small BSA, did have a smaller size, but more likely the HP model in order to obtain larger effective orifice area. Our further analysis demonstrated there was no relationship between the aortic valve lesion and the overall survival, and freedom from reoperation. In fact, among the 24 patients who required reoperation because of prosthetic valve dysfunction, the original aortic valve lesion was AR in 20 patients, AS in one, and ASR in 2 patients. Thus, the results essentially seem to be the same even if we include only AR patients in this study. We assume that this is partially because there were very few patients who had prosthesis-patient mismatch in this Japanese patient cohort.

• Kenji Minakata, MD, PhD
• Ryuzo Sakata, MD, PhD
• Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

(Released online December 25, 2015)

Reference

• 1.    Minakata  K,  Tanaka  S,  Okawa  Y,  Kaneko  T,  Okonogi  S,  Usui  A, et al. Twenty-year outcomes of aortic valve replacement with St. Jude Medical mechanical valves in Japanese patients. Circ J 2015; 79: 2380–2388.