title: Impact of patient-prosthesis mismatch in the aortic position: twenty-year experience with Korean patients.
abstract: OBJECTIVE
  The impact of patient-prosthesis mismatch (PPM) on clinical outcomes following aortic valve replacement (AVR) remains controversial. The study aim was to evaluate the impact of PPM on long-term clinical outcomes following AVR.
  
  
  METHODS
  Between January 1987 and September 2007, a total of 198 consecutive patients (mean age 59.6 +/- 10.5 years; range: 31-85 years) underwent isolated AVR for pure aortic stenosis at the authors' institutions. PPM was defined as an indexed effective orifice area (EOAI) < 0.85 cm2/m2, and was present in 45 patients (22.7%). The mean follow up duration was 102.6 +/- 71.6 months (maximum 270 months).
  
  
  RESULTS
  The early mortality was 1.5% (n = 3). The late mortality was similar in both the PPM and non-PPM groups (4.4% versus 4.7%; p = 0.950). The left ventricular mass index during follow up was higher in the PPM group (128.5 +/- 36.1 versus 114.5 +/- 39.1 g/m2, p = 0.037). Freedom from cardiac-related mortality at 15 years was 86.5 +/- 4.3% in the non-PPM group, and 92.9 +/- 4.9% in the PPM group (p = 0.282). Freedom from heart failure events at 15 years was 74.6 +/- 6.6% in the non-PPM group and 61.6 +/- 8.5% in the PPM group (p = 0.028). Predictors of heart failure events were female gender (p = 0.041, hazards ratio (HR) = 2.5, 95% confidence interval (CI) = 1.1-5.9) and PPM (p = 0.001, HR = 5.1, 95% CI = 1.9-13.7).
  
  
  CONCLUSIONS
  In AVR patients with pure aortic stenosis, PPM, when defined by the threshold value of EOAI < 0.85 cm2/m2, was not associated with differences in cardiac-related mortality. However, PPM was related to an increased incidence of postoperative heart failure events.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea.
authors.forename: Dong Seop
authors.initials: DS
authors.lastname: Jeong
authors.forename: Hyoung Woo
authors.initials: HW
authors.lastname: Chang
authors.forename: Kyung-Hwan
authors.initials: KH
authors.lastname: Kim
authors.forename: Hyuk
authors.initials: H
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery; D044466:Asian People / Q000706:statistics & numerical data*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome