Impact of prosthesis-patient mismatch in the mitral position on left atrial and pulmonary arterial pressures: a numerical study

Tanné, David; Kadem, Lyes; Rieu, Régis; Dumesnil, J. G.; Pibarot, P.

doi:10.1080/10255840512331389272

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“…4,5,8 We selected a value of 0.9 cm 2 /m 2 as the threshold for severe PPM because our previous numerical and clinical studies suggest that such a level of PPM is associated with moderate/severe pulmonary hypertension at rest and severe pulmonary hypertension on mild/ moderate physical exercise. 8,20 …”

Section: Ppm Definitionmentioning

confidence: 99%

Impact of Prosthesis-Patient Mismatch on Survival After Mitral Valve Replacement

et al. 2007

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Background-We recently reported that valve prosthesis-patient mismatch (PPM) is associated with persisting pulmonary hypertension after mitral valve replacement. Thus, the objective of this study was to evaluate the impact of PPM on mortality in patients undergoing mitral valve replacement. Methods and Results-The indexed valve effective orifice area was estimated for each type and size of prosthesis being implanted in 929 consecutive patients and used to define PPM as not clinically significant if Ͼ1.2 cm 2 /m 2 , as moderate if Ͼ0.9 and Յ1.2 cm 2 /m 2 , and as severe if Յ0.9 cm 2 /m 2 . Moderate PPM was present in 69% of patients; severe PPM was seen in 9%. For patients with severe PPM, 6-year survival (74Ϯ5%) and 12-year survival (63Ϯ7%) were significantly less than for patients with moderate PPM (84Ϯ1% and 76Ϯ2%; Pϭ0.027) or nonsignificant PPM (90Ϯ2% and 82Ϯ4%; Pϭ0.002). On multivariate analysis, severe PPM was associated with higher mortality (hazard ratio, 3.2; 95% confidence interval, 1.5 to 6.8; Pϭ0.003). Conclusions-Severe PPM is an independent predictor of mortality after mitral valve replacement. As opposed to other independent risk factors, PPM may be avoided or its severity may be reduced with the use of a prospective strategy at the time of operation. For patients identified as being at risk for severe PPM, every effort should be made to implant a prosthesis with a larger effective orifice area.

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