Impact of Valve Prosthesis-Patient Mismatch on Long-Term Survival and Left Ventricular Mass Regression After Aortic Valve Replacement for Aortic Stenosis

Abstract

The influence of prosthesis-patient mismatch on long-term results after aortic valve replacement remains controversial. The aim of this study was to evaluate the effect of prosthesis-patient mismatch on survival and the extent of left ventricular mass regression after aortic valve replacement for aortic stenosis. We retrospectively reviewed 146 patients who underwent isolated aortic valve replacement for aortic stenosis between 1990 and 2005. Prosthesis-patient mismatch was defined as an effective orifice area/body surface area <or=0.85 cm(2)/m(2). Mean follow-up was 4.5 +/- 3.3 years, with a total follow-up of 650.0 patient-years. In 108 patients, follow-up echocardiography was performed at least 6 months after surgery, and the extent of postoperative left ventricular mass regression was analyzed according to the presence of prosthesis-patient mismatch. Ten years after surgery, there was no significant difference between patients with mismatch and those without mismatch in overall survival (p = 0.345), actuarial freedom from cardiac-related death (p = 0.576), and freedom from any valve-related mortality or morbidity (p = 0.614). Using multivariate analysis, PPM was not a predictor of late cardiac-related death or all deaths. Echocardiographic examination showed that left ventricular wall thickness and left ventricular mass was significantly decreased postoperatively in both groups. However, the absolute and relative left ventricular mass regression was significantly lower in patients with mismatch than in those without mismatch. This study showed no negative effects of prosthesis-patient mismatch on survival at 10 years after aortic valve replacement for aortic stenosis. However, the extent of left ventricular mass regression was significantly lower in patients with mismatch.