Impact of prosthesis-patient mismatch on survival after mitral valve replacement.
BACKGROUND
We recently reported that valve prosthesis-patient mismatch (PPM) is associated with persisting pulmonary hypertension after mitral valve replacement. Thus, the objective of this study was to evaluate the impact of PPM on mortality in patients undergoing mitral valve replacement.


RESULTS
The indexed valve effective orifice area was estimated for each type and size of prosthesis being implanted in 929 consecutive patients and used to define PPM as not clinically significant if > 1.2 cm2/m2, as moderate if > 0.9 and < or = 1.2 cm2/m2, and as severe if < or = 0.9 cm2/m2. Moderate PPM was present in 69% of patients; severe PPM was seen in 9%. For patients with severe PPM, 6-year survival (74+/-5%) and 12-year survival (63+/-7%) were significantly less than for patients with moderate PPM (84+/-1% and 76+/-2%; P=0.027) or nonsignificant PPM (90+/-2% and 82+/-4%; P=0.002). On multivariate analysis, severe PPM was associated with higher mortality (hazard ratio, 3.2; 95% confidence interval, 1.5 to 6.8; P=0.003).


CONCLUSIONS
Severe PPM is an independent predictor of mortality after mitral valve replacement. As opposed to other independent risk factors, PPM may be avoided or its severity may be reduced with the use of a prospective strategy at the time of operation. For patients identified as being at risk for severe PPM, every effort should be made to implant a prosthesis with a larger effective orifice area.
Magne
Julien
J
Laval Hospital Research Center/Québec Heart Institute, Faculty of Medicine, Laval University, Québec, Canada.
Mathieu
Patrick
P
Dumesnil
Jean G
JG
Tanné
David
D
Dagenais
François
F
Doyle
Daniel
D
Pibarot
Philippe
P
D000368:Aged; D016208:Databases, Factual; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000706:statistics & numerical data*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000033:anatomy & histology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D009929:Organ Size; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D012307:Risk Factors; D016019:Survival Analysis