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Patient-Prosthesis Mismatch in Aortic Valve Replacement With No.19 Prosthesis: Impact on Early and Late Outcomes
Selman Dumani1, Alessia Mehmeti2, Ermal Likaj1
1Division of Cardiac Surgery, University Hospital Center "Mother Theresa", Tirana, ALB.
Introduction:
Patient-prosthesis mismatch (PPM) continues to be a crucial topic of discussion regarding its influence on the aortic valve surgery results. The aim of our study is to evaluate the incidence of mismatch and its influence on early and late results in aortic valve replacement using prosthesis No 19.
Methods:
A cohort of 175 patients underwent aortic valve replacement with prosthesis No-19 and was followed for up to 10 years. PPM was defined according to indexed effective orifice valve area (EOAi). Early results were evaluated through hospital mortality, and the data were collected from hospital recordings. Long-term follow-up was realized by contacting the patients by phone. The endpoints were mortality and the clinical status assessed by New York Heart Association (NYHA) class change after intervention.
Results:
The overall and severe mismatch incidence was 69.1% and 29.7%, respectively. Overall, hospital mortality is 3.4%. Severe mismatch (p=0.057) and continuous values of indexed effective orifice area (p = 0.079), adjusted for sex and age, do not affect early mortality. Severe mismatch and indexed effective orifice area were associated with less post-operative improvement of NYHA functional class (p<0.015) in the long term, independently from other predictors.
Conclusions:
Severe mismatch and small indexed orifice areas do not affect early and late mortality, but they are related, importantly, with less symptomatic improvement in the long-term outcomes.
Insights
Patient-prosthesis mismatch (PPM) after aortic valve replacement does not impact early or late mortality. However, severe mismatch is linked to reduced long-term symptomatic improvement in patients.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Patient-prosthesis mismatch (PPM) is a significant concern in aortic valve surgery outcomes.
- Prosthesis No. 19 was used in this study evaluating PPM incidence and impact.
Purpose of the Study:
- To assess the incidence of PPM in patients undergoing aortic valve replacement with prosthesis No. 19.
- To evaluate the influence of PPM on early and late outcomes, including mortality and functional status.
Main Methods:
- A cohort of 175 patients received aortic valve replacement with prosthesis No. 19, followed for up to 10 years.
- PPM was defined by indexed effective orifice area (EOAi).
- Outcomes included hospital mortality, long-term mortality, and New York Heart Association (NYHA) functional class changes.
Main Results:
- The incidence of overall and severe PPM was 69.1% and 29.7%, respectively.
- Severe PPM and indexed effective orifice area did not significantly affect early hospital mortality.
- Severe PPM and indexed effective orifice area were associated with less improvement in NYHA functional class long-term (p<0.015).
Conclusions:
- Severe PPM and small indexed orifice areas do not influence early or late mortality after aortic valve replacement.
- Importantly, severe mismatch is related to diminished symptomatic improvement in the long term.
