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Activity Number:
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138
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Type:
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Topic Contributed
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Date/Time:
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Monday, August 7, 2006 : 10:30 AM to 12:20 PM
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Sponsor:
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Biopharmaceutical Section
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| Abstract - #307152 |
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Title:
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Patient-Prosthesis Mismatch and Operative Mortality after Aortic Valve Replacement Surgery
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Author(s):
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Sean M. O'Brien*+ and Elizabeth R. DeLong and Lawrence H. Muhlbaier and Charles R. Bridges and Eric D. Peterson
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Companies:
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Duke University and Duke University and Duke University and University of Pennsylvania and Duke University
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Address:
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DUMC 3850, Durham, NC, 27710,
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Keywords:
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observational studies ; measurement error ; hidden confounders ; sensitivity analysis ; hierarchical models
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Abstract:
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Patient-prosthesis mismatch (PPM) following aortic valve replacement surgery is said to be present when the blood flow area of the prosthetic valve is too small relative to the patient's body size, leading to high pressure gradients. Guidelines now recommend not implanting a valve if the ratio of its effective orifice area relative to body surface area is less than 0.85. Yet, the clinical relevance and effects of PPM remain controversial. This paper describes numerous methodological challenges we encountered when analyzing the association between PPM and operative mortality in a large cardiac surgery registry. Issues we addressed include measurement error and sensitivity to hidden confounders. Our data suggest that while PPM may be causally related to increased operative mortality, the relationship is highly complex and may be confounded by numerous unmeasured variables.
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