Patient prosthesis mismatch after aortic valve replacement: An Indian perspective

Area of Science:

• Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• The perioperative period is critical for patient outcomes.
• Prosthetic-patient mismatch (PPM) can occur after aortic valve replacement (AVR).

Purpose of the Study:

• To determine the occurrence of PPM after AVR.
• To identify factors associated with PPM.
• To assess the impact of PPM on mortality.

Main Methods:

• Retrospective analysis of 606 AVR procedures over 4 years at a tertiary care cardiac center.
• Stratification of patients into PPM categories using Rahimtoola criteria (indexed effective orifice area).
• Comparison of factors associated with PPM between patient groups.

Main Results:

• The incidence of mild, moderate, and severe PPM was 6.1%, 2.5%, and 0.5%, respectively.
• PPM did not impact all-cause in-hospital mortality.
• PPM was more frequent in patients with aortic stenosis (AS) than aortic regurgitation (AR).
• Aortic annulus indexed to BSA (iAA) <16mm/m² BSA strongly predicted PPM.

Conclusions:

• PPM has a lower incidence in this Indian population post-AVR and does not elevate early mortality.
• Patients with AS and iAA <16mm/m² BSA require careful management to mitigate PPM risk.