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Impact of prosthesis-patient mismatch after mitral valve replacement in rheumatic population: Does mitral position

Seung Hyun Lee1, Byung Chul Chang1, Young-Nam Youn1

  • 1Division of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Yonsei University, College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Journal of Cardiothoracic Surgery
|October 12, 2017
PubMed
Abstract

Insights

Prosthesis-patient mismatch (PPM) after mitral valve replacement in rheumatic patients did not significantly impact long-term outcomes. This study found no association between PPM and adverse remodeling or survival rates.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Prosthetic Heart Valves

Background:

  • Prosthesis-patient mismatch (PPM) occurs when an implanted heart valve is too small for the patient's body surface area (BSA).
  • Rheumatic heart disease remains a significant cause of mitral valve disease globally, necessitating mitral valve replacement (MVR).

Purpose of the Study:

  • To investigate the long-term clinical outcomes in rheumatic patients undergoing MVR.
  • To determine the impact of PPM on post-MVR remodeling, survival, and tricuspid regurgitation (TR) progression.

Main Methods:

  • A cohort of 445 patients with rheumatic disease undergoing isolated MVR between 2000 and 2013 were analyzed.
  • Effective orifice area (EOA) was measured, and PPM was defined as indexed EOA (EOA/BSA) ≤ 1.2 cm²/m².
  • Clinical and echocardiographic data were collected for a mean follow-up of 8.7 years.

Main Results:

  • 37% of patients experienced PPM. No significant baseline differences were observed between groups, except for age and indexed EOA.
  • Both groups showed a decrease in mean trans-valvular pressure gradient (MPG) and left atrial/ventricular dimensions post-MVR, without significant inter-group differences.
  • Freedom from TR progression and overall survival rates at 3 and 5 years were similar between patients with and without PPM.

Conclusions:

  • Mitral valve prosthesis-patient mismatch (PPM) in rheumatic patients undergoing MVR does not appear to be associated with adverse atrial or ventricular remodeling.
  • PPM did not significantly influence late clinical outcomes, including survival and tricuspid regurgitation progression.
Keywords:
Heart valve prosthesisHemodynamicsMitral valveMortalitySurgeryValves

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