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Published on: July 18, 2014
Impact of valve prosthesis-patient mismatch on short-term mortality after aortic valve replacement
Claudia Blais1, Jean G Dumesnil, Richard Baillot
1Quebec Heart Institute/Laval Hospital, Laval University, Sainte-Foy, Quebec, Canada.
Background:
The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. This study examined if there is a relation between PPM and short-term mortality after operation.
Methods And Results:
The indexed valve effective orifice area (EOA) was estimated for each type and size of prosthesis being implanted in 1266 consecutive patients and used to define PPM as not clinically significant if >0.85 cm2/m2, as moderate if >0.65 cm2/m2 and
Conclusions:
PPM is a strong and independent predictor of short-term mortality among patients undergoing AVR, and its impact is related both to its degree of severity and the status of left ventricular function. In contrast to other risk factors, moderate-severe PPM can be largely avoided with the use of a prospective strategy at the time of operation.
Insights
Prosthesis-patient mismatch (PPM) after aortic valve replacement significantly increases short-term mortality risk. Careful prosthesis selection can mitigate this risk, especially in patients with reduced left ventricular function.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Aortic valve replacement (AVR) can lead to prosthesis-patient mismatch (PPM) when the prosthetic valve is too small for the patient's body size.
- PPM can result in elevated transvalvular pressure gradients, potentially impacting patient outcomes.
Purpose of the Study:
- To investigate the relationship between PPM and short-term mortality following AVR.
- To determine if PPM is an independent predictor of mortality after AVR.
Main Methods:
- Indexed valve effective orifice area (EOA) was calculated for 1266 AVR patients to define PPM severity (not significant, moderate, severe).
- PPM severity was correlated with 30-day mortality using multivariate analysis.
- The impact of PPM on mortality was assessed in relation to left ventricular ejection fraction.
Main Results:
- Moderate or severe PPM was identified in 38% of patients.
- PPM was a strong independent predictor of 30-day mortality (P=0.003).
- The relative risk of mortality increased 2.1-fold with moderate PPM and 11.4-fold with severe PPM.
Conclusions:
- PPM is a significant independent predictor of short-term mortality after AVR, with risk escalating with PPM severity.
- The impact of PPM on mortality is exacerbated by impaired left ventricular function.
- Prospective strategies during AVR can largely prevent moderate-to-severe PPM.
