English

Abstract

BACKGROUND Valve replacement has become the mainstay of management for rheumatic heart diseases. However, an important and frequent complication of valve replacement is patient prosthesis mismatch (PPM). The present study was undertaken to evaluate a single institution experience on the clinical pattern and presentation of PPM, and the outcomes of double valve replacement surgery. METHODS This retrospective, regional study was carried out among 316 consecutive patients who underwent concomitant aortic and mitral valve surgery (with or without tricuspid annuloplasty) in this tertiary care hospital. Particulars regarding the clinical profile and procedure details (valve types and sizes and priority of surgery) of these patients were documented from the medical records. RESULTS In this institute, the valves used were predominantly mechanical (92.6 %) when compared to bioprosthesis in 7.4 % (47/632 valves - 23 mitral position and 24 in aortic position). The most common sizes used in the aortic and mitral position were 21 mm & 27 mm respectively. In spite of the seemingly lower sizes used in the patients undergoing double valve replacement (DVR) the incidence of PPM is less owing to the fact that the population under study had a lower body surface area (BSA) and body mass index (BMI) - 1.17 ± 0.3 & 19.86 ± 3.9 respectively. CONCLUSIONS It may be emphasized that if the valve size required to be implanted is derived based on the patient’s BSA and indexed effective orifice area, the incidence of patient prosthesis mismatch can be minimized drastically and with it the in-hospital mortality and morbidity. KEYWORDS Aortic Stenosis, Double Valve Replacement, Mitral Valve, Prosthesis, Rheumatic Heart Disease