Original article
Adult cardiac
Patient-Prosthesis Mismatch in Patients With Aortic Stenosis Undergoing Isolated Aortic Valve Replacement Does Not Affect Survival

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.
https://doi.org/10.1016/j.athoracsur.2009.07.037Get rights and content

Background

Data suggest that patient-prosthesis mismatch (PPM) adversely effects late survival after aortic valve replacement (AVR). This study examined the incidence and implications of PPM in patients undergoing isolated AVR.

Methods

Prospectively collected data on patients undergoing isolated AVR for aortic stenosis between January 1, 1997 and December 31, 2007 were analyzed. The projected effective valve orifice area from in vivo data was indexed to body surface area (EOAi). PPM was defined as moderate for EOAi of ≤ 0.85 cm2/m2 and severe if ≤ 0.6 cm2/m2. The reference group comprised patients with EOAi > 0.85 cm2/m2. The effect of PPM on postoperative survival was assessed by multivariate analysis.

Results

Of 801 patients, PPM was severe in 48 (6.0%), moderate in 462 (57.8%), and nonexistent in 291 (36.4%). Mismatch was associated with increasing age and female gender, thus resulting in an increase in the EuroSCORE (reference group, 4.9 ± 2.6; moderate PPM, 5.8 ± 2.4; and severe PPM, 6.1±2.1; p < 0.001). PPM did not significantly increase hospital mortality. Four deaths occurred in the reference group (1.4%), 12 in the moderate PPM (2.6%), and none in the severe PPM group (p = 0.311). The 5-year survival estimates were 83% in reference, 86% in moderate PPM, and 89% in severe PPM (p = 0.25). By multivariate analysis, PPM was not an independent risk factor for reduced in-hospital or late survival.

Conclusions

Moderate PPM is common in patients undergoing AVR for aortic stenosis, but severe mismatch is rare. Patients with PPM have similar early and late postoperative survival rate.

Section snippets

Material and Methods

This study was approved by University Hospital Birmingham NHS Foundation Trust Research and Development Board (Project no. CA2–02355).

Results

Summary patient demographics, type of operation, and mismatch group are summarized in Table 1, Table 2. PPM was severe in 48 patients (6.0%) and moderate in 462 (57.8%). The remaining 291 patients (36.4%) had no PPM and were defined as the reference group. Mismatch was associated with increasing age and female gender, thus resulting in an increase in the mean EuroSCORE (reference group, 4.9 ± 2.6; moderate PPM, 5.8 ± 2.4; and severe PPM 6.1 ± 2.1; p < 0.001).

Despite the increasing operative

Comment

The main finding of this study is that although moderate mismatch was common, severe mismatch was rare, affecting only 6% of patients, and there was no significant adverse effect on in-hospital mortality or late survival in either mismatch group compared with the reference group irrespective of age, patient body mass index, or systolic function. The similar survival between the different mismatch groups was noted, despite the mismatch groups having a progressive increase in risk profile mainly

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