title: Prosthesis-patient mismatch causes a significantly increased risk of operative mortality in aortic valve replacement.
abstract: BACKGROUND
  Small aortic prosthesis can lead to prosthesis-patient mismatch (PPM). Implanting such small prosthesis remains a controversial issue. This study was done to investigate whether or not PPM causes an increased operative mortality in aortic valve replacement (AVR).
  
  
  METHODS
  Two-hundred-two consecutive patients undergoing primary AVR in a tertiary hospital were included. The sample was grouped according to the aortic valve prosthesis size: ≤21 mm (small) and >21 mm (standard). The effect of variables on outcomes was determined by univariate and multivariable regression analyses.
  
  
  RESULTS
  PPM was found significantly more among patients with AVR ≤ 21 mm (P < 0.0001). Moreover, the likelihood of mortality also was significantly higher in these patients (P < 0.0001). Univariate analysis demonstrated small prosthesis size, urgent operation, PPM, female gender, and NYHA Class IV as significant predictors of mortality. Multivariate regression identified female gender, PPM, and urgent operation as the key independent predictors of mortality.
  
  
  CONCLUSIONS
  PPM and female gender are significant predictors of mortality. Care should be taken to prevent PPM by implanting larger prosthesis especially in females.
authors.affiliation: MBBS- Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Khan Muhammad
authors.initials: KM
authors.lastname: Shahzeb
authors.affiliation: MBBS- Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Bawany Faizan
authors.initials: BF
authors.lastname: Imran
authors.affiliation: MBBS- Cardiac Surgery Department, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Khan
authors.initials: K
authors.lastname: Asadullah
authors.affiliation: MBBS- Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Hussain
authors.initials: H
authors.lastname: Mehwish
mesh_terms: D000328:Adult; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D019300:Medical Errors / Q000401:mortality*; D010154:Pakistan / Q000453:epidemiology; D011475:Prosthesis Failure; D017755:Prosthesis Fitting / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome