title: Does a minimally invasive approach increase the incidence of patient-prosthesis mismatch in aortic valve replacement?
abstract: OBJECTIVE
  The impact of a minimally invasive approach on patient-prosthesis mismatch (PPM) in patients undergoing aortic valve replacement (AVR) remains unknown. The study aim was to identify the impact of a minimally invasive approach for AVR on the incidence of PPM.
  
  
  METHODS
  The results of a single-center experience in 506 patients who underwent isolated AVR through a minimally invasive or conventional sternotomy were analyzed. Postoperative PPM was defined as an effective orifice area index < 0.85 cm2/m2, and was correlated with surgical approach, mortality and cardiac events after surgery.
  
  
  RESULTS
  Overall, postoperative PPM was present in 26.0% of the patients. The ratio of PPM was 24.1% in minimal access patients and 27.7% in conventional AVR patients (p = 0.35). Hospital mortality was similar in both groups (3.8% versus 3.4%, p = 0.62). The body mass index (BMI) was higher in patients with PPM (28.5 +/- 4.4 versus 25.3 +/- 3.6 kg/m2; p = 0.0001), but obesity was significantly associated with PPM (36.3% versus 9.4%; p = 0.0001). The PPM group included more patients with a left ventricular ejection fraction (LVEF) < 0.50 (12.8% versus 5.3%; p = 0.004). The independent risk factors for PPM were increased BMI (p = 0.0001), LVEF < 0.50 (p = 0.007) and preoperative aortic stenosis (p = 0.029). A LVEF < 0.50 increased the risk for PPM by 3.77-fold (95% CI: 1.4-9.9), while a high BMI increased the risk by 1.42-fold (95% CI: 1.3-1.5). Preoperative aortic insufficiency was associated with PPM, but did not significantly increase the risk.
  
  
  CONCLUSIONS
  A minimally invasive approach for AVR did not lead to an increased incidence of PPM and associated adverse events following surgery.
authors: Ihsan
authors: I
authors: Bakir
authors: Filip P
authors: FP
authors: Casselman
authors: Burak
authors: B
authors: Onan
authors: Frank
authors: F
authors: Van Praet
authors: Yvette
authors: Y
authors: Vermeulen
authors: Ivan
authors: I
authors: Degrieck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001530:Belgium / Q000453:epidemiology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome