Impact of Prosthesis-Patient Mismatch on Survival After Mitral Valve Replacement
- 20 March 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 115 (11), 1417-1425
- https://doi.org/10.1161/circulationaha.106.631549
Abstract
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 >1.2 cm 2 /m 2 , as moderate if >0.9 and ≤1.2 cm 2 /m 2 , and as severe if ≤0.9 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 (74±5%) and 12-year survival (63±7%) were significantly less than for patients with moderate PPM (84±1% and 76±2%; P =0.027) or nonsignificant PPM (90±2% and 82±4%; P =0.002). On multivariate analysis, severe PPM was associated with higher mortality (hazard ratio, 3.2; 95% confidence interval, 1.5 to 6.8; P =0.003). 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.Keywords
This publication has 32 references indexed in Scilit:
- Impact of Prosthesis–Patient Size on Functional Recovery After Aortic Valve ReplacementCirculation, 2005
- Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacementJournal of the American College of Cardiology, 2005
- Residual pulmonary artery hypertension after mitral valve replacement: Size matters!Journal of the American College of Cardiology, 2005
- Clinical Experience With Stentless Mitral Valve ReplacementThe Annals of Thoracic Surgery, 2005
- Doppler echocardiography of 119 normal-functioning St Jude Medical mitral valve prostheses: A comprehensive assessment including time-velocity integral ratio and prosthesis performance index*Journal of the American Society of Echocardiography, 2005
- Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valvesThe Journal of Thoracic and Cardiovascular Surgery, 2004
- Twenty-year experience with the St Jude Medical mechanical valve prosthesisThe Journal of Thoracic and Cardiovascular Surgery, 2003
- Small valve area index: its influence on early mortality after mitral valve replacementEuropean Journal of Cardio-Thoracic Surgery, 2000
- Doppler echocardiographic assessment with the continuity equation of St. Jude medical mechanical prostheses in the mitral valve positionThe American Journal of Cardiology, 1995
- Validation and applications of mitral prosthetic valvular areas calculated by Doppler echocardiographyThe American Journal of Cardiology, 1990