Share this page on LinkedIn
Share This Page on Google+
Share This Page on Twitter
tell someone about this page print this page
You are here: Contents > 2014 > Volume 23 Number 2 March 2014 > AORTIC VALVE DISEASE > Does a Minimally Invasive Approach Increase the Incidence of Patient-Prosthesis Mismatch in Aortic Valve Replacement?

Does a Minimally Invasive Approach Increase the Incidence of Patient-Prosthesis Mismatch in Aortic Valve Replacement?

Ihsan Bakir1, Filip P. Casselman, Burak Onan1, Frank Van Praet, Yvette Vermeulen, Ivan Degrieck

OLV Clinic, Department of Cardiovascular and Thoracic Surgery, Aalst, Belgium

Background and aim of the study: The impact of a minimally invasive approach on patient-prosthesis mismatch (PPM) in patients undergoing aortic valve replacement (AVR) remains unknown. The study aim was to identify the impact of a minimally invasive approach for AVR on the incidence of PPM.

Methods: The results of a single-center experience in 506 patients who underwent isolated AVR through a minimally invasive or conventional sternotomy were analyzed. Postoperative PPM was defined as an effective orifice area index <0.85 cm2/m2, and was correlated with surgical approach, mortality and cardiac events after surgery.

Results: Overall, postoperative PPM was present in 26.0% of the patients. The ratio of PPM was 24.1% in minimal access patients and 27.7% in conventional AVR patients (p = 0.35). Hospital mortality was similar in both groups (3.8% versus 3.4%, p = 0.62).


The body mass index (BMI) was higher in patients with PPM (28.5 ± 4.4 versus 25.3 ± 3.6 kg/m2; p = 0.0001), but obesity was significantly associated with PPM (36.3% versus 9.4%; p = 0.0001). The PPM group included more patients with a left ventricular ejection fraction (LVEF) <0.50 (12.8% versus 5.3%; p = 0.004). The independent risk factors for PPM were increased BMI (p = 0.0001), LVEF <0.50 (p = 0.007) and preoperative aortic stenosis (p = 0.029). A LVEF <0.50 increased the risk for PPM by 3.77-fold (95% CI: 1.4-9.9), while a high BMI increased the risk by 1.42-fold (95% CI: 1.3-1.5). Preoperative aortic insufficiency was associated with PPM, but did not significantly increase the risk.

Conclusion: A minimally invasive approach for AVR did not lead to an increased incidence of PPM and associated adverse events following surgery.

The Journal of Heart Valve Disease 2014;23:161-167

Does a Minimally Invasive Approach Increase the Incidence of Patient-Prosthesis Mismatch in Aortic Valve Replacement?

Click the above hyperlink to view the article, right click (Ctrl click on a Mac) to open in a new browser window or tab.

Purchase this Article

Please click the button below to purchase this article. Single article purchases are provided at $50.00 per article. Upon clicking the button below, single article user account subscription details are requested and, upon successful payment, a single article user account is created. Single articles are availble in your account for seven days after purchase.