Influence of patient-prosthesis mismatch on long-term results after aortic valve replacement with a stented bioprosthesis.
OBJECTIVE
The study aim was to compare long-term results of bioprostheses implanted in the aortic position, with and without patient-prosthesis mismatch (defined as effective orifice area (EOA)/body surface area (BSA) < or =0.85 cm2/m2).


METHODS
Between 1986 and 1990, 90 consecutive patients (mean age 72.6 years; mean BSA 1.77+/-0.2 m2) each received an aortic Medtronic Intact valve (19 mm, n = 35; 21 mm, n = 29; >23 mm, n = 26). Of these patients, 64 had a patient-prosthesis mismatch, and 26 had no mismatch. Median follow up was 7.3 years.


RESULTS
At 10 years postoperatively, there was no significant inter-group difference in actuarial freedom from thromboembolism (90.7% in mismatch group, 79.6% in no-mismatch group; p = 0.16), hemorrhage (86% versus 83.3%; p = 0.59), endocarditis (98.2% versus 86.7%; p = 0.1), structural valve deterioration (97% versus 100%; p = 0.57) and reoperation (96.4% versus 94.8%; p = 0.2). At the same time, overall actuarial survival was 42.1+/-6.5% in the mismatch group and 22.6+/-8.6% in the no-mismatch group (p = 0.08). By multivariate analysis, the main risk factor for late death was a preoperative left ventricular ejection fraction (LVEF) <50% (p = 0.001). Freedom from cardiac death was 70+/-6% and 35.7+/-11% in the mismatch and no-mismatch groups respectively (p = 0.005), but this was not significantly different when LVEFs were paired (LVEF >50% p = 0.33, LVEF <50% p = 0.28). The NYHA functional status of survivors showed 94.4% of the mismatch group and 100% of the no-mismatch group to be in NYHA classes I and II (p = 1).


CONCLUSIONS
Within this patient population it was not possible to demonstrate any negative effects of patient-prosthesis mismatch at 10 years after Intact aortic valve replacement; the LVEF was the only predictor for late death.
Frapier
Jean M
JM
Department of Cardiac Surgery, Arnaud de Villeneuve Hospital, CHU, Montpellier, France.
Rouvière
Philippe
P
Razcka
Franck
F
Aymard
Thierry
T
Albat
Bernard
B
Chaptal
Paul A
PA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome