Patient-prosthesis mismatch after small-size stentless aortic valve replacement.
OBJECTIVE
The aim of this study was to determine the occurrence of patient-prosthesis mismatch (P-PM) after aortic valve replacement (AVR) with a small-size Cryolife O'Brien (CLOB) bioprosthesis and to evaluate its clinical and hemodynamic implications.


METHODS
Sixty-two patients (mean age 70.9 +/- 5.2 years, 77.8% females), receiving a labeled 21-23 mm CLOB between 1993 and 2000, were retrospectively studied. Effective orifice area (EOA) was calculated by the continuity equation and then indexed to the patient's body surface area (BSA) to obtain the indexed EOA (EOAI). Based on previous observations a mismatch was defined as EOAI <or= 0.85 cm2/m2.


RESULTS
Twelve patients (20%) at discharge, two (3.3%) at 6 months and none at late controls had an EOAI <or= 0.85 cm2/m2. At ANOVA determinants of mismatch were female sex (p < 0.001), age (p = 0.01), and patient's annulus index (PAI, p < 0.001). Patients with mismatch had higher mean gradients (MG, p = 0.01, and p < 0.001 at discharge and 6 months, respectively) and EOAI correlated with MG at discharge (r2= 0.72, p < 0.001) and 6-month (r2= 0.40, p = 0.001) studies. At 1 year no difference in MG was detected between patients with or without mismatch (p = ns) and EOAI did not correlate with MG (r2= 0.01, p = ns). Midwall fractional shortening did not differ in patients with or without mismatch (p = ns). Patients with an EOAI >or= 0.8 cm/m2 showed an earlier concentric remodeling up to 1 year; no difference was demonstrated at later studies between groups. Survival and clinical status results were not affected by an EOAI <or= 0.85 cm2/m2.


CONCLUSIONS
After AVR with CLOB mismatch occurred early postoperatively in a small number of patients without clinical repercussions. EOAI, significantly increasing over time, was adequate to BSA in all patients at late controls.
Gelsomino
Sandro
S
Department of Cardiovascular Sciences, General Hospital "S.Maria della Misericordia", Udine, Italy. sandrogelsomino@virgilio.it
Morocutti
Giorgio
G
Masullo
Gianluca
G
Da Col
Paolo
P
Frassani
Romeo
R
Spedicato
Leonardo
L
Livi
Ugolino
U
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology