title: Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status.
abstract: BACKGROUND
  The definition and incidence of patient-prosthesis mismatch (PPM) in the mitral position are unclear.
  
  
  OBJECTIVE
  To determine the impact of PPM on late survival and functional status after mitral valve replacement with a mechanical valve.
  
  
  METHODS
  Between 1992 and 2005, 714 patients (mean [± SD] age 60±10 years) underwent valve replacement with either St Jude (St Jude Medical Inc, USA) (n=295) or Carbomedics (Sulzer Carbomedics Inc, USA) (n=419) valves. There were 52 concomitant procedures (50 tricuspid annuloplasties, 25 foramen oval closures and 20 radiofrequency mazes). The mean clinical follow-up period was 4.4±3.3 years. The severity of PPM was established with cut-off values for an indexed effective orifice area (EOAi) of lower than 1.2 cm(2)⁄m(2), lower than 1.3 cm(2)⁄m(2) and lower than 1.4 cm(2)⁄m(2). Parametric and nonparametric tests were used to determine predictors of outcome.
  
  
  RESULTS
  The prevalence of PPM was 3.7%, 10.1% and 23.5% when considering values of lower than 1.2 cm(2)⁄m(2), lower than 1.3 cm(2)⁄m(2) and lower than 1.4 cm(2)⁄m(2), respectively. When considering functional improvement, patients with an EOAi of 1.4 cm(2)⁄m(2) or greater had a better outcome than those with an EOAi of lower than 1.4 cm(2)⁄m(2) (OR 1.98; P=0.03). When building a Cox-proportional hazard model, PPM with an EOAi of less than 1.3 cm(2)⁄m(2) was an independent predictive factor for midterm survival (HR 2.24, P=0.007). Other factors affecting survival were age (HR 1.039), preoperative New York Heart Association class (HR 1.96) and body surface area (HR 0.31).
  
  
  CONCLUSIONS
  In a large cohort of patients undergoing mitral valve replacement with mechanical prostheses, PPM defined as an EOAi of lower than 1.3 cm(2)⁄m(2) significantly decreased midterm survival. This level of PPM was observed in 10.2% of patients. Patients with an EOAi of 1.4 cm(2)⁄m(2) or greater had greater improvement of their functional status.
authors.affiliation: Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Quebec, Canada. denis.bouchard@icm-mhi.org
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vanden Eynden
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
authors.forename: Arsène J
authors.initials: AJ
authors.lastname: Basmadjian
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
mesh_terms: D000368:Aged; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011475:Prosthesis Failure; D016896:Treatment Outcome