Prosthesis-Patient Mismatch Causes a Significantly Increased Risk of Operative Mortality in Aortic Valve Replacement
DOI:
https://doi.org/10.1532/HSF98.2013304Abstract
Background: Small aortic prosthesis can lead to prosthesis-patient mismatch (PPM). Implanting such small prosthesis remains a controversial issue. This study was done to investigate whether or not PPM causes an increased operative mortality in aortic valve replacement (AVR).
Methods: Two-hundred-two consecutive patients undergoing primary AVR in a tertiary hospital were included. The sample was grouped according to the aortic valve prosthesis size: ?21 mm (small) and >21 mm (standard). The effect of variables on outcomes was determined by univariate and multivariable regression analyses.
Results: PPM was found significantly more among patients with AVR ? 21mm (P < 0.0001). Moreover, the likelihood of mortality also was significantly higher in these patients (P < 0.0001). Univariate analysis demonstrated small prosthesis size, urgent operation, PPM, female gender, and NYHA Class IV as significant predictors of mortality. Multivariate regression identified female gender, PPM, and urgent operation as the key independent predictors of mortality.
Conclusion: PPM and female gender are significant predictors of mortality. Care should be taken to prevent PPM by implanting larger prosthesis especially in females.
References
Blais C, Dumesnil JG, Baillot R, Simard S, Doyle D, Pibarot P. 2003. Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation 8:983-988.nConcistrè G, Dell'aquila A, Pansini S et al. 2013. Aortic valve replacement with smaller prostheses in elderly patients: does patient prosthetic mismatch affect outcomes? J Card Surg 28(4):341-7.nDavid TE, Puschmann R, Ivanov J et al. 1998. Aortic valve replacement with stentless and stented porcine valves: a case-match study. J Thorac Cardiovasc Surg 116:236-241.nFlameng W, Meuris B, Herijgers P, Herregods MC. 2006. Prosthesis-patient mismatch is not clinically relevant in aortic valve replacement using the Carpentier-Edwards Perimount valve. Ann Thorac Surg 8:530-536.nFrapier JM, Rouviere P, Razcka F, Aymard T, Albat B, Chaptal PA. 2002. Influence of patient-prosthesis mismatch on long-term results after aortic valve replacement with a stented bioprosthesis. J Heart Valve Dis 8:543-551.nHowell NJ, Keogh BE, Barnet V et al. 2006. Patient-prosthesis mismatch does not affect survival following aortic valve replacement. Eur J Cardiothorac Surg 8:10-14.nKoene BM, Hamad MAS, Bouma W et al. 2013. Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement. J Cardiothorac Surg 8:96.nLaPar DJ, Ailawadi G, Bhamidipati CM et al. 2011. Small prosthesis size in aortic valve replacement does not affect mortality. Ann Thorac Surg 92:880-8.nMascherbauer J, Rosenhek R, Fuchs C et al. 2008. Moderate patient-prosthesis mismatch after valve replacement for severe aortic stenosis has no impact on short-term and long-term mortality. Heart 8:1639-1645.nMedalion B, Blackstone EH, Lytle BW, White J, Arnold JH, Cosgrove DM. 2000. Aortic valve replacement: is valve size important? J Thorac-Cardiovasc Surg 8:963-974.nMonin JL, Monchi M, Kirsch ME et al. 2007. Low-gradient aortic stenosis: impact of prosthesis-patient mismatch on survival. Eur Heart J 8:2620-2626.nMoon MR, Pasque MK, Munfakh NA et al. 2006. Prosthesis-patient mismatch after aortic valve replacement: impact of age and body size on late survival. Ann Thorac Surg 8:481-488.nNozohoor S, Nilsson J, Luhrs C, Roijer A, Sjogren J. 2007. The influence of patient-prosthesis mismatch on in-hospital complications and early mortality after aortic valve replacement. J Heart Valve Dis 8:475-482.nPibarot P, Dumesnil JG. 2009. Valvular Heart Disease: Changing Concepts in Disease Management. Circulation 119: 1034-1048.nRao V, Jamieson WR, Ivanov J, Armstrong S, David TE. 2000. Prosthesis patient mismatch affects survival after aortic valve replacement. Circulation 102(19 Suppl 3):III5-9.nSedrakyan A, Hebert P, Vaccarino V et al. 2004. Quality of life after aortic valve replacement with tissue and mechanical implants. J Thorac Cardiovasc Surg 128:266-272.nTasca G, Mhagna Z, Perotti S et al. 2006. Impact of prosthesis-patient mismatch on cardiac events and midterm mortality after aortic valve replacement in patients with pure aortic stenosis. Circulation 8:570-576.nTjang YS, van Hees Y, Körfer R, Grobbee DE, van der Heijden GJ. 2007. Predictors of mortality after aortic valve replacement. Eur J Cardiothorac Surg 32(3):469-74.nUrso 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? Interact CardiovascThorac Surg 8:510-518.nWalther T, Rastan A, Falk V et al. 2006. Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement. Eur J Cardiothorac Surg 8:15-19.n
