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You are here: Contents > 2013 > Volume 22 Number 1 January 2013 > AORTIC VALVE DISEASE > Impact of Patient-Prosthesis Mismatch in the Aortic Position: Twenty-Year Experience with Korean Patients

Impact of Patient-Prosthesis Mismatch in the Aortic Position: Twenty-Year Experience with Korean Patients

Dong Seop Jeong, Hyoung Woo Chang, Kyung-Hwan Kim, Hyuk Ahn

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea

Background and aim of the study: The impact of patient-prosthesis mismatch (PPM) on clinical outcomes following aortic valve replacement (AVR) remains controversial. The study aim was to evaluate the impact of PPM on long-term clinical outcomes following AVR. Methods: Between January 1987 and September 2007, a total of 198 consecutive patients (mean age 59.6 ± 10.5 years; range: 31-85 years) underwent isolated AVR for pure aortic stenosis at the authors’ institutions. PPM was defined as an indexed effective orifice area (EOAI <0.85cm²/m², and was present in 45 patients (22.7%). The mean follow up duration was 102.6 ± 71.6 months (maximum 270 months). Results: The early mortality was 1.5% (n = 3). The late mortality was similar in both the PPM and non-PPM groups (4.4% versus 4.7%; p = 0.950). The left ventricular mass index during follow up was higher in the PPM group (128.5 ± 36.1 versus

114.5 ± 39.1 g/m², p = 0.037). Freedom from cardiac-related mortality at 15 years was 86.5 ± 4.3% in the non-PPM group, and 92.9 ± 4.9% in the PPM group (p = 0.282). Freedom from heart failure events at 15 years was 74.6 ± 6.6% in the non-PPM group and 61.6 ± 8.5% in the PPM group (p = 0.028). Predictors of heart failure events were female gender (p = 0.041, hazards ratio (HR) = 2.5, 95% confidence interval (CI) = 1.1-5.9) and PPM (p = 0.001, HR = 5.1, 95% CI = 1.9-13.7). Conclusion: In AVR patients with pure aortic stenosis, PPM, when defined by the threshold value of EOAI <0.85 cm²/m², was not associated with differences in cardiac-related mortality. However, PPM was related to an increased incidence of postoperative heart failure events.

The Journal of Heart Valve Disease 2013;22:56-63

Impact of Patient-Prosthesis Mismatch in the Aortic Position: Twenty-Year Experience with Korean Patients

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