Consideration of prosthesis?patient mismatch and left ventricular mass regression after implantation of the Carpentier?Edwards pericardial valve in elderly Japanese patients: body surface area may be irrelevant

Abstract

The assessment of prosthesis patient mismatch (PPM) for small aortic annulus is important for prognosis after aortic valve replacement (AVR). Recent investigations have demonstrated that PPM occurs in AVR patients with an indexed effective orifice area (iEOA) of less than 0.85 cm2/m2. We investigated hemodynamic performance and left ventricular mass (LVM) regression after AVR. Eighteen patients who underwent AVR using a 19-mm Carpentier-Edwards pericardial (CEP) valve without annular enlargement were studied by echocardiography and Doppler examination 4 months after AVR. Patients were divided into two groups on the basis of their body surface area (BSA); the smaller BSA (group S, 1.14-1.36 m2, nine patients) and the larger BSA (group L, 1.40-1.83 m2, nine patients). Of these 18 patients, ten underwent isolated AVR, and five underwent AVR with coronary artery bypass graft; (i.e., double valvular replacement, AVR with maze procedure, and AVR with mitral valvulophasty. There were no statistically significant differences between the two groups, except for age (group S, 78.3+/-2.5 years; group L, 73.6+/-2.4 years). There was no significant difference for the iEOA during the late phase at rest (group S, 1.10+/-0.26 cm2; group L, 1.02+/-0.28 cm2). However, there was a significant difference for the LVM regression between the preoperative and postoperative values (group S, 243+/-23.6 mg/cm2 [pre], 190+/-16.9 mg/cm2 [post]; group L, 302+/-13.7 mg/cm2 [pre], 199+/-16.7 mg/cm2 [post]). In elderly Japanese patients with a BSA of less than 18 m2, we demonstrated LVM regression and avoidance of PPM after implantation of the aortic 19-mm CEP valve.