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Eur J Cardiothorac Surg 2006;30:15-19
© 2006 Elsevier Science NL

Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement

Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Strümpellstrasse 39, 04289 Leipzig, Germany

Received 29 December 2005; received in revised form 2 April 2006; accepted 13 April 2006.

^_* Corresponding author. Tel.: +49 341 865 1424; fax: +49 341 865 1452. (Email: walt{at}medizin.uni-leipzig.de).

Objective: The aim of this study was to evaluate the impact of patient prosthesis mismatch (PPM) and additional risk factors on outcome after aortic valve replacement (AVR). Methods: Four thousand one hundred and thirty-one patients who were operated between May 1996 and April 2004 were evaluated. One thousand eight hundred and fifty-six patients received bileaflet mechanical AVR and 2275 stented xenograft AVR. PPM was defined as severe if manufacturers effective orifice area (EOA) divided by body surface area (BSA) was < 0.65 cm²/m² and as moderate in the range of 0.65–0.85 cm²/m². PPM, age, gender, EOA index, emergency indication for surgery (within 24 h), EuroSCORE as well as requirement for additional procedures were tested. Univariate (Fisher's exact test) and multivariate logistic regression analysis as well as survival analysis (Kaplan–Meier) were performed. Results: Severe PPM was present in 97 (2.4%) and moderate PPM in 1103 (26.7%) patients. PPM occurs more frequently with xenograft AVR. In-hospital mortality was 5.2% for severe, 10.6% for moderate and 6.9% with no PPM (p = 0.018, OR 1.4). Moderate PPM was independently predictive for short- and long-term mortality. Further analysis revealed patient age > 70 years (n = 1589, p = 0.002, OR 1.85), emergency indication (n = 374, p < 0.001, OR 4.4), EuroSCORE > 10 (n = 494, p < 0.001, OR 4.7) and additional cardiac procedures (n = 2049, p < 0.001, OR 2.0) as predictors for adverse outcome after AVR. Conclusion: Severe PPM is rare; moderate PPM is present in a quarter of patients. PPM has a significant impact on short- and long-term mortality after AVR.

Key Words: Aortic valve replacement • Stented aortic valve prosthesis • Patient prosthesis mismatch

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