Effect of prosthesis-patient mismatch on survival after aortic valve replacement using mechanical prostheses in patients with aortic stenosis

Abstract

Although PPM may affect operative mortality, the effect of PPM appears to decrease over time. PPM had no effect on late survival.

Operative Management – Patient-Prosthesis Mismatch

“…Urso et al showed improvement in postoperative NHYA class and regression of LVMI during long-term follow-up in patients who underwent AVR with a 19-mm mechanical valve 12 . We also showed that PPM with an EOAI ≥0.75 cm 2 /m 2 but <0.85 cm 2 /m 2 has no effect on operative, short-term, and long-term survival and the effect of PPM with an IEOA <0.75 cm 2 /m 2 on survival appeared to decrease over time 11 . Surviving patients with an IEOA <0.75 cm 2 /m 2 showed good long-term survival.…”

“…Such degree of PPM may be acceptable in not only elderly patients but also younger patients 7 . We also reported that the postoperative peak pressure gradient across the prosthesis was significantly higher in patients with PPM than in patients without PPM, but postoperative cardiac function, including LV function, LVMI, and NYHA class, improved in all patients despite having PPM; the degree of improvement in cardiac function in patients with PPM compared favorably to that in patients without PPM 11 . Avoiding the risk of severe PPM, must always be considered, but, it is more important to consider whether the benefits of avoiding PPM overcome the drawbacks of other complicated measures in each individual patient.…”

“…However, LV workload remains high after AVR due to persistent PPM, which may increase LVM again during the follow-up period. On the other hand, many studies have been reported that mild to moderate PPM appears to have little or no effect on postoperative recovery of cardiac function, late cardiac events and survival [5][6][7][8][9][10][11][12] . Such degree of PPM may be acceptable in not only elderly patients but also younger patients 7 .…”

“…In general, PPM is considered to be present when an indexed EOA (IEOA) adjusted for body surface area (BSA) is <0.85 cm 2 /m 2 2-4 . Although, many studies have shown that PPM adversely affects survival and postoperative cardiac function [2][3][4] , many studies contradict these findings [5][6][7][8][9][10][11][12] . Thus, there is considerable controversy regarding the effects of PPM on survival and postoperative recovery of cardiac functions.…”

Long-Term Survival Following Aortic Valve Replacement: the Influence of Age, Prosthesis-Patient Mismatch and Indexed Effective Orifice Area

“…[26] This analysis included a number of studies that failed to demonstrate a significant effect of PPM, amongst which were one study [27] with a longer mean follow-up (9.1 vs. 7.8 years) and a second [28] with a comparable follow-up (median of 7.3 vs. 7.3 years) to our study. Both these studies failed to show a significant effect on survival, raising the possibility that a longer follow-up may be salient.…”