HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Neil J. Howell Bruce E. Keogh Robert S. Bonser Timothy R. Graham Stephen J. Rooney Ian C. Wilson Domenico Pagano Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Howell, N. J. Articles by Pagano, D. Search for Related Content PubMed PubMed Citation Articles by Howell, N. J. Articles by Pagano, D. Related Collections Valve disease

Eur J Cardiothorac Surg 2006;30:10-14
© 2006 Elsevier Science NL

Patient-prosthesis mismatch does not affect survival following aortic valve replacement

Department of Cardiothoracic Surgery, University Hospital NHS Foundation Trust, Birmingham, UK

Received 28 November 2005; received in revised form 2 March 2006; accepted 14 March 2006.

^_* Corresponding author. Address: Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham B15 2TH, UK. Tel.: +44 121 627 2850; fax: +44 121 627 2895. (Email: domenico.pagano{at}uhb.nhs.uk).

Objective: Patient-prosthesis mismatch (PPM) has been reported to increase perioperative mortality and reduce postoperative survival in patients undergoing aortic valve replacement (AVR). We analysed the effect of PPM at values predicting severe mismatch on survival following AVR in our unit. Methods: Prospectively collected data on 1481 consecutive patients who had undergone AVR with or without coronary artery revascularisation between 1997 and 2005 were analysed. Projected in vitro valve effective orifice area (EOA) and geometric prosthesis internal orifice area (GOA) were evaluated and values were indexed to body surface area (cm² m^–2). PPM was defined as EOAi < 0.6 and/or GOAi < 1.1. Long-term survival data were obtained from the National Institute of Statistics. Results: One thousand four hundred and eighteen patients were identified. 67/1418 (4.7%) patients had GOAi < 1.1; 122/1418 (8.6%) had EOAi < 0.6 and 38 (2.6%) patients exhibited both forms of mismatch. One thousand two hundred and sixty-seven patients (89%) demonstrated no mismatch (reference group). There were 75 in-hospital deaths (overall mortality 5.3%) with no significant difference between the mismatch and the reference groups. Survival data were available for up to 8 years (median 36 months, IQR 6–60 months). There were 160 late deaths (13/143 PPM group vs 147/1198 reference group). The 5-year survival estimate was similar for both groups (83% PPM group; 81% reference group; p = 0.47). Cox-hazard analysis identified advanced age as the only predictor of reduced survival (age > 80, RR 2.13, 95% CI 1.38–4.586, p = 0.004). Conclusions: Severe patient-prosthesis mismatch was predicted in 4–10% of patients undergoing AVR but this did not affect in-hospital mortality or mid-term survival.

Key Words: Aortic valve disease • Aortic valve replacement

This article has been cited by other articles:

				G. Casali, G. Luzi, M. Vicchio, P. Lilla della Monica, G. Minardi, and F. Musumeci Echocardiographic Follow-Up after Implanting 17-mm Regent Mechanical Prostheses Asian Cardiovasc Thorac Ann, June 1, 2008; 16(3): 208 - 211. [Abstract] [Full Text] [PDF]

				S Bleiziffer, W B Eichinger, I Hettich, D Ruzicka, M Wottke, R Bauernschmitt, and R Lange Impact of patient-prosthesis mismatch on exercise capacity in patients after bioprosthetic aortic valve replacement Heart, May 1, 2008; 94(5): 637 - 641. [Abstract] [Full Text] [PDF]

				P. Totaro and V. Argano Patient prosthesis mismatch after mitral valve replacement: Myth or reality? J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 697 - 701. [Abstract] [Full Text] [PDF]

				P. Pibarot and J. G Dumesnil Prevention of valve prosthesis--patient mismatch before aortic valve replacement: does it matter and is it feasible? Heart, May 1, 2007; 93(5): 549 - 551. [Abstract] [Full Text] [PDF]

				S. Bleiziffer, W. B Eichinger, I. Hettich, R. Guenzinger, D. Ruzicka, R. Bauernschmitt, and R. Lange Prediction of valve prosthesis-patient mismatch prior to aortic valve replacement: which is the best method? Heart, May 1, 2007; 93(5): 615 - 620. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola Is severe valve prosthesis-patient mismatch (VP-PM) associated with a higher mortality? Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 1 - 1. [Full Text] [PDF]