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 > 2016 > Volume 25 Number 5 September 2016 > MITRAL VALVE DISEASE > Mitral Patient-Prosthesis Mismatch Predicts Suboptimal Hemodynamic Recovery after Mitral Valve Replacement

Mitral Patient-Prosthesis Mismatch Predicts Suboptimal Hemodynamic Recovery after Mitral Valve Replacement

Sertan Ozyalcin1, Kerem M. Vural1,3, Ayse Colak2

1Cardiovascular Surgery, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
2Cardiology, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
3Electronic correspondence: kvural@tr.net

Background and aim of the study: A possible relationship between an obstructive prosthesis and suboptimal hemodynamic recovery, as reflected by unsatisfactory regression in systolic pulmonary artery pressure (sPAP) and functional tricuspid regurgitation (FTR) following mitral valve replacement (MVR), was investigated. A delineating effective orifice area index (EOAI) value was sought in order to define a patient-prosthesis mismatch.

Methods: A total of 128 patients undergoing isolated mechanical MVR were followed up for a mean of 46 ± 9 months. Patients were allocated to two groups. Group I comprised 83 patients (65%) exhibiting a satisfactory (≥30%) regression in sPAP and FTR, while group II comprised 45 patients with a <30% (suboptimal) decrease in these parameters. A cutoff value for the prosthetic mitral valve in-vivo EAOI was explored as a predictor of postoperative hemodynamic recovery.


Results: The mean in-vivo EOAI differed significantly between the groups (1.23 cm2/m2 in group I versus 1.11 cm2/m2 in group II; p <0.0001). The consequent receiver operating characteristic curve analysis revealed an EOAI of 1.19 cm2/m2 as the cut-off value, below which a suboptimal postoperative regression in pulmonary hypertension and FTR is predicted.

Conclusion: An in-vivo EOAI <1.19 cm2/m2 strongly suggests a suboptimal hemodynamic recovery following MVR with the bileaflet mechanical prosthesis used in the present study. Although no direct relationship between prosthesis size and in vivo EOAI was demonstrated, the logical approach is to implant a prosthesis of the largest possible size.

The Journal of Heart Valve Disease 2016;25:589-595


Mitral Patient-Prosthesis Mismatch Predicts Suboptimal Hemodynamic Recovery after Mitral 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.