title: Rigorous patient-prosthesis matching of Perimount Magna aortic bioprosthesis.
abstract: BACKGROUND
  Severe patient-prosthesis mismatch, defined as effective orifice area index ≤0.65 cm(2) m(-2), has demonstrated poor long-term survival after aortic valve replacement. Reported rates of severe mismatch involving the Perimount Magna aortic bioprosthesis range from 4% to 20% in patients with a small annulus.
  
  
  METHODS
  Between June 2008 and August 2011, 251 patients (mean age 70.5 ± 10.2 years; mean body surface area 1.55 ± 0.19 m(2)) underwent aortic valve replacement with a Perimount Magna bioprosthesis, with or without concomitant procedures. We performed our procedure with rigorous patient-prosthesis matching to implant a valve appropriately sized to each patient, and carried out annular enlargement when a 19-mm valve did not fit. The bioprosthetic performance was evaluated by transthoracic echocardiography predischarge and at 1 and 2 years after surgery.
  
  
  RESULTS
  Overall hospital mortality was 1.6%. Only 5 (2.0%) patients required annular enlargement. The mean follow-up period was 19.1 ± 10.7 months with a 98.4% completion rate. Predischarge data showed a mean effective orifice area index of 1.21 ± 0.20 cm(2) m(-2). Moderate mismatch, defined as effective orifice area index ≤0.85 cm(2) m(-2), developed in 4 (1.6%) patients. None developed severe mismatch. Data at 1 and 2 years showed only two cases of moderate mismatch; neither was severe.
  
  
  CONCLUSIONS
  Rigorous patient-prosthesis matching maximized the performance of the Perimount Magna, and no severe mismatch resulted in this Japanese population of aortic valve replacement patients.
authors.affiliation: Cardiovascular Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Cardiovascular Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan hyamaguchi@med.showa-u.ac.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: Cardiovascular Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Takagaki
authors.affiliation: Cardiovascular Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Kadowaki
authors.affiliation: Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakao
authors.affiliation: Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Amano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design / Q000379:methods; D016896:Treatment Outcome
keywords: Aortic valve stenosis; bioprosthesis; echocardiography; heart valve prosthesis implantation; mortality; treatment outcome