Abstract
BackgroundProsthesis–patient mismatch (PPM) may affect the clinical outcomes of patients undergoing aortic valve replacement (AVR). We aimed to determine the incidence of PPM, its effect on short-term mortality, and the factors contributing to PPM in China.MethodsWe retrospectively examined all consecutive patients with isolated or concomitant AVR at our hospital between January 1, 2013 and December 31, 2015. PPM was defined as an effective orifice area index (EOAi) of ≤ 0.85 cm2/m2. The baseline, echocardiographic, operative, and outcome data of all patients were collected from the national database.ResultsA total of 869 patients were included in the study. PPM was detected in 15.9% (138/869) of the patients. Four patients (0.5%) met the criteria for severe PPM. Patients with PPM were older and had a higher prevalence of diabetes, coronary heart disease, aortic stenosis (AS), and preoperative left ventricular dysfunction but a lower incidence of smoking history and aortic regurgitation. Logistic regression analysis showed that female gender (P < 0.001), AS (P = 0.014), higher body mass index (BMI) (P < 0.001), and bioprosthesis (P < 0.001) were independent predictors of PPM. We also found that PPM (P = 0.005) was associated with 30-day all-cause mortality, along with smoking history (P = 0.001) and low preoperative left ventricular ejection fraction (LVEF) (P = 0.004).ConclusionsPPM is associated with high short-term mortality after AVR in China. Female gender, aortic stenosis, bioprosthesis, and high BMI are risk factors for the incidence of PPM.
Highlights
Prosthesis–patient mismatch (PPM) may affect the clinical outcomes of patients undergoing aortic valve replacement (AVR)
The incidence of smoking history and aortic regurgitation was relatively low in Prosthesis-patient mismatch (PPM) patients (Table 2)
Factors affecting prosthesis-patient mismatch According to a multivariate logistic regression analysis including all preoperative and intraoperative variables, patients with PPM had a higher incidence of female gender (P < 0.001; Odd ratio (OR) = 0.307; 95% Confidence interval (CI), 0.19–0.486), a higher incidence of aortic stenosis (AS) (P = 0.014; OR = 1.725; 95% CI, 1.118–2.663), higher body mass index (BMI) (P < 0.001; OR = 1.092; 95% CI, 1.029–1.160), and more frequently received a bioprosthesis (P < 0.001; OR = 13.907; 95% CI, 8.703–22.222) than those without a mismatch (Table 4)
Summary
Prosthesis–patient mismatch (PPM) may affect the clinical outcomes of patients undergoing aortic valve replacement (AVR). We aimed to determine the incidence of PPM, its effect on short-term mortality, and the factors contributing to PPM in China. Prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR) surgery was first mentioned in 1978 by Rahimtoola, and has been a topic of discussion ever since [1]. PPM occurs when the effective orifice area (EOA) of the implanted prosthesis is too small in relation to the patient’s body size. Some studies have showed favorable results despite the occurrence of PPM after AVR [2,3,4], while several other clinical studies have demonstrated that aortic PPM might be associated with an increased incidence of long- and short-term adverse outcomes, including cardiac-related death [5, 6]. The incidence, predictions and complications of PPM in East China patients might differ greatly from patients in the western countries
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