Prosthesis-patient mismatch after mitral valve replacement: a single-centered retrospective analysis in East China

Armah M Akuffu,Junnan Zheng,Yiming Ni,Haige Zhao

doi:10.1186/s13019-018-0788-4

Armah M Akuffu, Junnan Zheng + Show 2 more

Open Access

https://doi.org/10.1186/s13019-018-0788-4

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Abstract

BackgroundProsthesis–patient mismatch (PPM) may affect the clinical outcomes of patients undergoing mitral valve replacement (MVR) surgery. We aimed to investigate the incidence of PPM of the mitral position in our center and analyze the possible predictors of PPM as well as its effect on short-term outcomes.MethodsWe retrospectively examined all consecutive patients with isolated or concomitant MVR at our center from 2013 to 2015. PPM was defined as an indexed effective orifice area (iEOA) of ≤1.2 cm2/m2. After inclusion and exclusion, a total of 1067 patients were analyzed. The baseline information were collected and compared between the two groups. Multivariate logistic regression analysis was conducted to determine the preoperative predictors of PPM as well as the effect of PPM on early mortality.ResultsA total of 1067 patients were included in the study. PPM was detected in 15.9% of the patients while 12 patients (1.12%) met the criteria for severe PPM. Patients with PPM compared to the non-PPM patients had higher age, larger body surface area and were more likely to be male and obese. Logistic regression analysis showed that higher age, larger BSA, bioprosthesis and smaller left ventricle end-diastolic diameter were predictors of PPM. There were no significant differences between the PPM and non-PPM groups regarding post-operative complications. Logistic regression analysis showed that PPM was not a risk factor of short-term mortality (P = 0.654). Also, there were no significant differences regarding short−/mid-term heart function between the PPM and non PPM groups (P = 0.902).ConclusionsOur results demonstrated that higher age, bioprosthesis, larger BSA and smaller left ventricle size were associated with mitral PPM. However, PPM was not associated with poorer early outcomes after MVR surgery. In eastern of China, the prevalence of mitral valve stenosis is high; therefore, whether the standard PPM criteria are suitable for patients of this district needs to be further verified.

Highlights

Prosthesis–patient mismatch (PPM) may affect the clinical outcomes of patients undergoing mitral valve replacement (MVR) surgery
Mitral prosthesis-patient mismatch (PPM) was detected in 17.71% (189/1067) of the patients and only 12 (1.12%) patients met the criteria for severe PPM
PPM and valve prosthesis size We analyzed the association among age, weight, height, Body surface area (BSA) and valve size (Fig. 2)

Summary

Introduction

Prosthesis–patient mismatch (PPM) may affect the clinical outcomes of patients undergoing mitral valve replacement (MVR) surgery. PPM is considered a condition in which the effective orifice area (EOA) of the implanted valve prosthesis does not match the patient’s body size. Researches has shown that the EOA of mitral valve prosthesis is often too small in relation to body size, normally functioning mitral prosthesis often has relatively high transvalvular gradients similar to those found in mild to moderate mitral valve stenosis patients [6,7,8,9,10]. In East Asia, where rheumatic mitral valve stenosis is very common, the mitral valve annulus in patients is Akuffu et al Journal of Cardiothoracic Surgery (2018) 13:100 relatively small; more patients meet the standard of mitral PPM [11]. We will discuss the eligibility of the current PPM standard for this population

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