title: Moderate Patient-Prosthesis Mismatch Has No Negative Effect on Patients' Functional Status After Aortic Valve Replacement With CarboMedics Prosthesis.
abstract: BACKGROUND
  Patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) is the subject of continuing debate in the cardiac surgery field.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the frequency and severity of patient-prosthesis mismatch (PPM) and the functional status of patients undergoing aortic valve replacement (AVR) using a CarboMedics prosthesis in the mid-term follow up.
  
  
  METHODS
  We retrospectively studied 66 consecutive patients who were referred to AVR with a CarboMedics prosthesis at the Rajaie cardiovascular medical and research center, a university referral hospital in Tehran, Iran. The severity of PPM as well as clinical and echocardiographic parameters and the patients' New York heat association (NYHA) functional classification status, operative data and postoperative complications, and mortality in a mid-term (4 - 5 months) follow up period was assessed. Severe PPM was defined as the effective orifice area (EOA) indexed to the patient's body surface area (BSA) < 0.65 cm(2)/m(2) and moderate PPM was defined as the indexed effective orifice area (IEOA) between 0.65 and 0.85 cm(2)/m(2).
  
  
  RESULTS
  Of the 66 studied patients, 39 were male and 27 were female. The mean age of the patients was 43 ± 17 with a range of 6 - 76 years. Implanted sizes of the CarboMedics AV prosthesis in 22 patients were 19 and 21 mm, and in 44 patients were 23 and 25 mm. Eleven patients had moderate PPM (IEOA < 0.85 cm(2)/m(2)) and 55 of them did not have PPM (IEOA ≥ 0.85 cm(2)/m(2)). There were no statistically significant differences between the two groups in the echocardiographic trans-aortic pressure gradients (35.6 ± 19 vs. 23.2 ± 16 mmHg; P = 0.061) and the mean NYHA functional classification (1.10 ± 0.3 vs. 1.01 ± 0.10; P = 0.074) after AVR in the mid-term follow up.
  
  
  CONCLUSIONS
  Moderate PPM has no negative effect on echocardiographic trans-aortic pressure gradients or the patients' NYHA functional status after AVR with a CarboMedics prosthesis in the mid-term follow up.
authors.affiliation: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Alizadeh-Ghavidel
authors.affiliation: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Rasoul
authors.initials: R
authors.lastname: Azarfarin
authors.affiliation: Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Azin
authors.initials: A
authors.lastname: Alizadehasl
authors.affiliation: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Sadeghpour-Tabaei
authors.affiliation: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Ziae
authors.initials: Z
authors.lastname: Totonchi
keywords: Aortic Valve; Echocardiography; Follow-Up Studies; Heart Valve Prosthesis