Impact of prosthesis-patient mismatch on early haemodynamic status after aortic valve replacement.
Prosthesis-patient mismatch (PPM) has been reported to impact early haemodynamic status and early mortality after prosthetic aortic valve replacement (AVR) in patients with aortic stenosis (AS). The aim of this study was to assess the impact of PMM on early haemodynamic status after AVR using vasoactive-inotropic dependency index (VDI), postoperative pressures and end-organ perfusion.



A total of 183 patients with AS were included in this prospective cohort study, and underwent elective AVR with or without combined coronary artery bypass graft surgery. PPM was defined as a projected indexed effective orifice area of ≤0.85 cm2/m2, and was present in 27.9% of the patients. The primary end-point was the VDI [VDI = vasoactive-inotropic score/mean arterial pressure] measured upon admission to the intensive care unit (POD0) and on the morning of the first postoperative day (POD1). The secondary end-points were the following: mean left atrial pressure, mean central venous pressure, fluid balance, brain natriuretic peptide, troponin I, glomerular filtration rate and lactate levels on POD0 and POD1.



No significant differences in VDI were observed between the no PPM and PPM groups on POD0 (0.08 ± 0.48 vs 0.05 ± 0.13, respectively, P = 0.622) or on POD1 (0.09 ± 0.40 vs 0.06 ± 0.13, respectively; P = 0.583). The mean arterial pressure, mean left atrial pressure, central venous pressure, troponin I, glomerular filtration rate and lactate levels did not differ between the two groups on POD0 and POD1, as well as fluid balance and brain natriuretic peptide on POD1.



PPM is not associated with early haemodynamic status impairment and end-organ perfusion after AVR.



ClinicalTrials.gov number, NCT00699673.
Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France michel.kindo@chru-strasbourg.fr.
Michel
M
Kindo
Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
Tam Hoang
TH
Minh
Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
Stéphanie
S
Perrier
Department of Cardiology, Strasbourg University Hospital, France.
Hélène
H
Petit-Eisenmann
Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
Jonathan
J
Bentz
Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
Mircea
M
Cristinar
Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
Gharib
G
Ajob
Surgical Intensive Care Unit and Anesthesiology, University Hospitals of Strasbourg, France.
Olivier
O
Collange
Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
Jean-Philippe
JP
Mazzucotelli
D000368:Aged; D001024:Aortic Valve Stenosis / Q000097:blood / Q000503:physiopathology* / Q000601:surgery*; D001026:Coronary Artery Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D017755:Prosthesis Fitting; D013997:Time Factors; D016896:Treatment Outcome
D020097:Natriuretic Peptide, Brain
Aortic stenosis; Cardiac surgery; Prosthetic heart valves; Quality and outcomes of care; Valve disease surgery