(CCSP111) HEMODYNAMIC PERFORMANCE OF THE AORTIC CARPENTIER-EDWARDS MAGNA EASE BIOPROSTHESIS ACCORDING TO SEX AND PROSTHESIS SIZE

Background: Patient-prosthesis mismatch (PPM) has been associated with early valve degeneration and increased long-term mortality after aortic valve replacement (AVR). This study aims to evaluate the hemodynamic performance of the Carpentier-Edwards Magna Ease (CEME) aortic bioprosthesis by comparing men and women as well as different prosthesis sizes.

METHODS AND RESULTS: Patients who underwent an AVR with a CEME bioprosthesis between 2012 and 2022 were assessed using databases from two cardiac surgery centers (n=1062). The incidence of moderate or severe PPM was evaluated according to the manufacturer chart (predicted) and according to a published chart of measured effective orifice areas reported in literature. Sex and valve size (divided into 3 groups: 19 mm+21 mm, 23 mm, ≥25 mm) comparisons were performed. Among the 1062 patients, 32.0% (n=340) were women and the mean age of the cohort was 72 years. A greater body surface area was observed in men (W: 1.7+/-0.2 m2, M: 1.9+/-0.2 m2, p< 0.001). Eighty-one percent (n=176) of women received 19mm and 21mm prostheses compared to only 16.3% (n=115) of men. Predicted PPM from the manufacturer’s charts was observed in 2.1% (n=7) of women and 0.28% (n=2) of men (p < 0.001). When the literature chart definitions were used, PPM was found in 45% (n=150) of women and 18% (n=128) of men (p < 0.001). Adjusting for a body mass index (BMI) of >30, as described by the same authors, decreased the PPM by half (W: 21% (n=69), M: 9.3% (n=66), p< 0.001). The mean aortic gradient was higher in women in the overall cohort (W: 16+/-6 mm Hg, M: 14+/-6 mm Hg, p< 0.001). In this cohort, 391 patients (37.2%) benefited from 19 or 21mm bioprostheses, 374 (35.6%) from a 23 mm and 286 (27.2%) from ≥25 mm prostheses sizes. The incidence of predicted PPM compared to the literature chart values was 2% (n=8) vs 58% (n=228) in the 19+21 mm group, 0.27% (n=1) vs 13% (n=47) in the 23 mm group and 0% vs 1.1% (n=3) in the ≥25 mm valves sizes (p < 0.001). The PPM significantly decreased in each group when adjusting for BMI (p < 0.001).

Conclusion: There is a greater proportion of PPM and a higher transvalvular gradient in women. The PPM predicted from the manufacturer's charts appears to underestimate the incidence of PPM as opposed to the measured values. An adjustment of the PPM thresholds is suggested in patients with a BMI >30 due to the significant decrease in PPM observed.