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08:31

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The impact of patient-prosthesis mismatch on late outcomes after mitral valve replacement

Buu-Khanh Lam1, Vincent Chan, Paul Hendry

  • 1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. bklam@ottawaheart.ca

The Journal of Thoracic and Cardiovascular Surgery
|May 30, 2007
PubMed
Abstract

Insights

Patient-prosthesis mismatch after mitral valve replacement is common and linked to heart failure and pulmonary hypertension. Choosing a larger prosthesis improves long-term survival for patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Biomedical Engineering

Background:

  • Patient-prosthesis mismatch (PPM) after mitral valve replacement (MVR) is a concern.
  • Its impact on long-term outcomes like heart failure, pulmonary hypertension, and survival remains unclear.

Purpose of the Study:

  • To determine the incidence of PPM after MVR.
  • To assess the effect of PPM on recurrent congestive heart failure, postoperative pulmonary hypertension, and late survival.

Main Methods:

  • Retrospective analysis of 884 patients undergoing MVR (1985-2005).
  • PPM defined as indexed effective orifice area ≤ 1.25 cm²/m².
  • Clinical and echocardiographic follow-up for mean 5.1 years.

Main Results:

  • PPM incidence was 32%.
  • PPM predicted recurrent heart failure and poor late survival (10-year survival: 65% with PPM vs. 75% without).
  • PPM was not a predictor of postoperative pulmonary hypertension.

Conclusions:

  • PPM is frequent after MVR and associated with adverse outcomes.
  • Recurrent heart failure and reduced late survival are linked to PPM.
  • Implanting appropriately sized prostheses is crucial for MVR patients.

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