Impact of patient-prosthesis mismatch on 30-day outcomes in young and middle-aged patients undergoing aortic valve replacement

Daniel Hernández-Vaquero,Carlos Morales,Rubén Álvarez,Jose López,Francisco Boye,Zain Khalpey,Juan C Llosa,Rocío Díaz

doi:10.1186/1749-8090-7-46

Abstract

BackgroundThe impact of patient-prosthesis mismatch (PPM) on early outcomes in young and middle-aged patients undergoing conventional aortic valve replacement for severe aortic stenosis remains unknown. Our objective was to evaluate the incidence of some degree of PPM and its influence on early mortality and morbidity.MethodsWe analyzed our single center experience in all patients <70 years undergoing first-time isolated aortic valve replacement for severe stenosis in our center from September 2007 to September 2011. PPM was defined as an indexed effective orifice area ≤ 0,85 cm2/m2. The influence of PPM on early mortality and postoperative complications was studied using propensity score analysis. Follow up at 30 postoperative days was 100% complete.ResultsOf 199 patients studied, 61 (30,7%) had some degree of PPM. PPM was associated with an increased postoperative mortality (OR = 8,71; 95% CI = 1,67–45,29; p = 0,04) and major postoperative complications (OR = 2,96; CI = 1,03–8,55; p = 0,044). However, no association between PPM and prolonged hospital or ICU stay was demonstrated.ConclusionsModerate PPM is a common finding in young and middle-aged patients undergoing surgery for aortic valve replacement due to severe stenosis. In addition, its influence on early outcomes may be relevant.

Highlights

The impact of patient-prosthesis mismatch (PPM) on early outcomes in young and middle-aged patients undergoing conventional aortic valve replacement for severe aortic stenosis remains unknown
Patient-prosthesis mismatch (PPM) after an Aortic valve replacement (AVR) was first defined by Rahimtoola [3] as the situation in which the effective area of a well-functioning prosthetic valve is less than that of a normal human valve
Sixty-one (30,7%) patients had some degree of PPM and their indexed effective orifice area (IEOA) was 0,76 (0,71–0,81) versus 1,08 (0,95–1,19) in the patients with no PPM

Summary

Introduction

The impact of patient-prosthesis mismatch (PPM) on early outcomes in young and middle-aged patients undergoing conventional aortic valve replacement for severe aortic stenosis remains unknown. Left ventricular hypertrophy caused by severe aortic stenosis (SAS) is associated with sudden death, congestive heart failure and stroke [2]. Aortic valve replacement (AVR) has been shown to change the natural history of these patients [1] reducing the pressure gradient between the left ventricle and ascending aorta and reversing left ventricular remodeling. If some degree of residual aortic stenosis remains after replacement reverse remodeling may be compromised. Patient-prosthesis mismatch (PPM) after an AVR was first defined by Rahimtoola [3] as the situation in which the effective area of a well-functioning prosthetic valve is less than that of a normal human valve. Whereas some researchers have reported a lower postoperative survival rate among patients with PPM [4,5], others have not observed these adverse results [6,7]

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