ORIGINAL ARTICLES

Valvular heart disease

Moderate patient-prosthesis mismatch after valve replacement for severe aortic stenosis has no impact on short-term and long-term mortality

J Mascherbauer¹, R Rosenhek¹, C Fuchs¹, E Pernicka², U Klaar¹, C Scholten¹, M Heger¹, G Wollenek³, G Maurer¹, H Baumgartner¹

¹ Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
² Department of Medical Statistics, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
³ Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

Dr Julia Mascherbauer, Adult Congenital and Valvular Heart Disease Center, University Hospital Münster, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany; julia.mascherbauer{at}ukmuenster.de

Background: The importance of moderate patient-prosthesis mismatch (PPM) for the prognosis of patients who undergo aortic valve replacement is unclear.

Methods: The presence of PPM was assessed in 361 consecutive patients undergoing valve replacement for isolated severe aortic stenosis and related to perioperative and postoperative mortality. Indexed effective orifice areas (EOAi) were estimated for each type and size of prosthesis.

Results: Using the previously proposed cut-off of EOAi 0.8 cm²/m², PPM was present in 54% of patients. Patients were followed for 4.1 (2.0) years. Survival tended to be slightly, but insignificantly, worse in the group with PPM (1-year, 3-year and 5-year survival 89%, 86% and 76% vs 92%, 88% and 82%; p = 0.21). However, patients with PPM were also older (p<0.0001), more often female (p<0.0001), more symptomatic (p = 0.001), more often had coronary artery disease (p = 0.04), triple vessel disease (p = 0.03) and hypertension (p = 0.01) and presented with a higher EuroSCORE (p<0.0001). By multivariate analysis only EuroSCORE and diabetes but not PPM were independent predictors of survival.

Conclusions: Moderate PPM is a frequent finding after aortic valve replacement. In our patient population it had no impact on short-term and long-term survival. It may therefore not be justified to recommend complex surgical interventions to avoid moderate PPM in patients undergoing aortic valve replacement for isolated severe aortic stenosis.

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This article has been cited by other articles:

• Urso, S., Sadaba, R., Aldamiz-Echevarria, G. (2009). Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?. ICVTS 9: 510-518 [Abstract] [Full Text]  
• Monin, J.-L. (2009). Prosthesis-patient mismatch: myth or reality?. Heart 95: 948-952 [Full Text]  
• Dumesnil, J G, Magne, J, Girerd, N, Pibarot, P (2009). Moderate patient-prosthesis mismatch can impact on mortality after aortic valve replacement. Heart 95: 592-592 [Full Text]  
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