Impact of Patient–Prosthesis Mismatch Following Aortic Valve Replacement on Short-Term Survival: A Retrospective Single Center Analysis of 632 Consecutive Patients with Isolated Stented Biological Aortic Valve Replacement

Abstract

Objectives The impact of patient–prosthesis mismatch (PPM) after aortic valve replacement (AVR) on short-term and long-term mortality remains controversial. The objective of this study was to evaluate the incidence and severity of PPM and its impact on short-term survival in a large cohort of patients treated with isolated stented biological AVR in a single institution.

Methods We analyzed retrospectively data of 632 consecutive patients with aortic stenosis undergoing isolated stented biological AVR between January 2007 and February 2012 at our institution. PPM was defined as an indexed effective orifice area ≤ 0.85 cm²/m². Statistical analyses were performed to identify influencing variables on valve size implanted.

Results Of the 632 patients investigated, 46% were females and mean age was 71.9 ± 10.4 years. PPM was observed in 93.8% (593 of 632 patients). In 71% of the patients, moderate (0.65–0.85 cm²/m²) PPM was present and in 22.8% severe (< 0.65 cm²/m²) PPM was present. The 30-day mortality was 1.4% (9 of 632 patients) with all being females. PPM was not associated with increased 30-day mortality. Multiple regression analyses demonstrated the usefulness of sex, height, body mass index, and body surface area as simultaneous predictors of the valve size implanted (R ² = 0.39).

Conclusion PPM had no discernable impact on short-term survival, although it was present in 93.8% of our patients following isolated stented biological AVR.

Keywords

aortic valve and root - heart valve surgery - outcomes (mortality morbidity)

• References

• 1 Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation 1978; 58 (1) 20-24
• 2 Dumesnil JG, Honos GN, Lemieux M, Beauchemin J. Validation and applications of indexed aortic prosthetic valve areas calculated by Doppler echocardiography. J Am Coll Cardiol 1990; 16 (3) 637-643
• 3 Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol 2000; 36 (4) 1131-1141
• 4 Del Rizzo DF, Abdoh A, Cartier P, Doty D, Westaby S. Factors affecting left ventricular mass regression after aortic valve replacement with stentless valves. Semin Thorac Cardiovasc Surg 1999; 11 (4) (Suppl. 01) 114-120
• 5 Milano AD, De Carlo M, Mecozzi G , et al. Clinical outcome in patients with 19-mm and 21-mm St. Jude aortic prostheses: comparison at long-term follow-up. Ann Thorac Surg 2002; 73 (1) 37-43
• 6 Kukucka M, Pasic M, Dreysse S , et al. Patient-prosthesis mismatch after transapical aortic valve implantation: incidence and impact on survival. J Thorac Cardiovasc Surg 2013; 145 (2) 391-397
• 7 Blais C, Dumesnil JG, Baillot R, Simard S, Doyle D, Pibarot P. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation 2003; 108 (8) 983-988
• 8 Mohty D, Dumesnil JG, Echahidi N , et al. Impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: influence of age, obesity, and left ventricular dysfunction. J Am Coll Cardiol 2009; 53 (1) 39-47
• 9 Florath I, Albert A, Rosendahl U, Ennker IC, Ennker J. Impact of valve prosthesis-patient mismatch estimated by echocardiographic-determined effective orifice area on long-term outcome after aortic valve replacement. Am Heart J 2008; 155 (6) 1135-1142
• 10 Tasca G, Mhagna Z, Perotti S , et al. Impact of prosthesis-patient mismatch on cardiac events and midterm mortality after aortic valve replacement in patients with pure aortic stenosis. Circulation 2006; 113 (4) 570-576
• 11 Moon MR, Pasque MK, Munfakh NA , et al. Prosthesis-patient mismatch after aortic valve replacement: impact of age and body size on late survival. Ann Thorac Surg 2006; 81 (2) 481-488 , discussion 489
• 12 Pibarot P, Dumesnil JG, Cartier PC, Métras J, Lemieux MD. Patient-prosthesis mismatch can be predicted at the time of operation. Ann Thorac Surg 2001; 71 (5, Suppl): S265-S268
• 13 Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation 2009; 119 (7) 1034-1048
• 14 Head SJ, Mokhles MM, Osnabrugge RL , et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J 2012; 33 (12) 1518-1529
• 15 Howell NJ, Keogh BE, Barnet V , et al. Patient-prosthesis mismatch does not affect survival following aortic valve replacement. Eur J Cardiothorac Surg 2006; 30 (1) 10-14
• 16 Blackstone EH, Cosgrove DM, Jamieson WR , et al. Prosthesis size and long-term survival after aortic valve replacement. J Thorac Cardiovasc Surg 2003; 126 (3) 783-796
• 17 Hong S, Yi G, Youn YN, Lee S, Yoo KJ, Chang BC. Effect of the prosthesis-patient mismatch on long-term clinical outcomes after isolated aortic valve replacement for aortic stenosis: a prospective observational study. J Thorac Cardiovasc Surg 2013; 146 (5) 1098-1104
• 18 Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. J Thorac Cardiovasc Surg 1979; 78 (3) 402-412
• 19 Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax 1970; 25 (3) 339-346