The influence of patient-prosthesis mismatch on in-hospital complications and early mortality after aortic valve replacement.
OBJECTIVE
The study aim was to analyze the relationship between patient-prosthesis mismatch (PPM) and in-hospital complications and mortality after aortic valve replacement (AVR).


METHODS
AVR was performed in 1,819 patients between January 1996 and July 2006. Follow up investigations were performed after a mean of 4.3 years (range: 0 days to 10.6 years). Univariate and multivariate analysis were used to evaluate risk factors for in-hospital complications and mortality in patients with prosthesis mismatch. Actuarial statistics were used to calculate survival rates.


RESULTS
Multivariate analysis showed that PPM (defined as indexed effective orifice area < or = 0.85 cm2/m2) was associated with an increased risk of postoperative neurological events (OR 2.26, 95% CI 1.05-4.83, p = 0.037). There were no significant differences in 30-day mortality between the PPM and non-PPM groups. Neither was any significant difference found between the two groups regarding long-term survival adjusted for significant risk factors for death after AVR.


CONCLUSIONS
The results suggest PPM to be an independent predictor of postoperative neurological complications in patients undergoing AVR. However, PPM did not negatively influence either short- or long-term survival. PPM may play an important role in selected categories of patients, and should be considered in order to avoid postoperative neurological complications.
Nozohoor
Shahab
S
Departments of Cardiothoracic Surgery, Lund University Hospital, Lund, Sweden.
Nilsson
Johan
J
Lührs
Carsten
C
Roijer
Anders
A
Sjögren
Johan
J
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013548:Sweden