title: Factors determining patient-prosthesis mismatch after aortic valve replacement--a prospective cohort study.
abstract: OBJECTIVE
  "Patient-prosthesis mismatch" (PPM) after aortic valve replacement (AVR) has been reported to increase morbidity and mortality. Although algorithms have been developed to avoid PPM, factors favouring its occurrence have not been well defined.
  
  
  METHODS
  This was a prospective cohort study performed at the Medical University of Vienna.
  
  
  METHODS
  361 consecutive patients who underwent aortic valve replacement for isolated severe aortic stenosis were enrolled.
  
  
  METHODS
  Patient- as well as prosthesis-related factors determining the occurrence of moderate and severe PPM (defined as effective orifice area indexed to body surface area ≤ 0.8 cm(2)/m(2)) were studied.
  
  
  RESULTS
  Postoperatively, 172 patients (48%) were diagnosed with PPM. The fact that predominantly female patients were affected (58% with PPM diagnosis in women versus 36% in men, p<0.001) was explained by the finding that they had smaller aortic root diameters (30.5±4.7 mm versus 35.3±4.2 mm, p<0.0001) and a higher proportion of bioprosthetic valves (82% versus 62%, p<0.0001), both independent predictors of PPM (aortic root diameter: OR 0.009 [95% CI, 0.004;0.013]; p = 0.0003, presence of bioprosthetic valve: OR 0.126 [95% CI, 0.078;0.175]; p<0.0001).
  
  
  CONCLUSIONS
  The occurrence of PPM is determined by aortic root diameter and prosthesis type. Novel sutureless bioprostheses with optimized hemodynamic performance or transcatheter aortic valves may become a promising alternative to conventional bioprosthetic valves in the future.
authors: Department of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors: Diana
authors: D
authors: Bonderman
authors: Alexandra
authors: A
authors: Graf
authors: Andreas A
authors: AA
authors: Kammerlander
authors: Alfred
authors: A
authors: Kocher
authors: Guenter
authors: G
authors: Laufer
authors: Irene M
authors: IM
authors: Lang
authors: Julia
authors: J
authors: Mascherbauer
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure