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DOI: 10.1055/s-2005-862079
Impact of patient prosthesis mismatch on short- and long-term outcome after aortic valve replacement
Objective: Aim of this study was to evaluate the impact of patient prosthesis mismatch (PPM) and of additional surgical risk factors after aortic valve replacement (AVR).
Material and Methods: 4131 patients operated from 05/96 until 04/04 were evaluated. 1856 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 <0.65cm2/m2 and as moderate if 0.65 to 0.85cm2/m2. PPM, age, gender, EOA-index, emergency indication for surgery (within 24h), Euroscore as well as requirement for additional procedures were tested. Univariate (chi square, power 0.96) and multivariate logistic regression analysis as well as survival analysis were performed.
Results: Severe PPM was present in 97 (2.4%) and moderate PPM in 1103 (26.7%) patients, respectively. PPM occurs more frequently with Xenograft AVR. In hospital (30-day) mortality was 5.2% with severe, 10.6% with moderate and 6.9% with no PPM (p=0.018, OR 1.4). PPM was independently predictive for short- and long-term mortality. Further analysis revealed patient age >70 years (n=1589, p=0.002, OR 1.5), emergency indication (n=374, p<0.001, OR 3.2), Euroscore >10 (n=494, p<0.001, OR 2.7) and requirement for additional procedures (n=2049, p<0.001, OR 1.8) as independent predictors for adverse outcome after AVR.
Conclusions: Severe PPM is rare, moderate PPM is present in a quarter of patients in this large series. PPM has a significant impact on short- and long-term mortality after AVR.