Key result
Severe patient prosthesis mismatch occurred in 16% of bioprosthetic aortic valve replacements, was more common in females, and was associated with 8% in-hospital mortality vs 2.3% for no mismatch.
Why the study?
Does severe prosthesis-patient mismatch worsen in-hospital outcomes in patients undergoing bioprosthetic aortic valve replacement for aortic stenosis?
Cohort (n=311)
Does severe prosthesis-patient mismatch worsen in-hospital outcomes in patients undergoing bioprosthetic aortic valve replacement for aortic stenosis?
Absolute Event Rate: 8% vs 2.3%
Severe prosthesis-patient mismatch after bioprosthetic aortic valve replacement is highly prevalent in females and is associated with increased in-hospital mortality and longer hospital stays.
Severe PPM was associated with higher mortality; hypothesis-generating for prevention trials before practice change.
OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of .0.85 cm(2)/m, 0.85-0.66 cm(2)/m(2), and <0.65 cm(2)/m(2), respectively. RESULTS: A total of 311 bioprosthetic patients were identified. The incidence of nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 41%, 42, and 16%, respectively. Severe Patient Prosthesis Mismatch was significantly more prevalent in females (82%). In severe Patient Prosthesis Mismatch, the perfusion and the crossclamp times were considerably lower when compared with nonsignificant Patient Prosthesis Mismatch and moderate Patient Prosthesis Mismatch. Patients with severe Patient Prosthesis Mismatch had a significantly higher likelihood of spending time in the intensive care unit and a significantly longer length of stay in the hospital. Body surface area was not different in severe Patient Prosthesis Mismatch when compared with nonsignificant Patient Prosthesis Mismatch. In-hospital mortality in patients with nonsignificant, moderate, and severe Patient Prosthesis Mismatch was 2.3%, 6.1%, and 8%, respectively. Minimally invasive surgery was significantly associated with moderate Patient Prosthesis Mismatch in 49% of the patients, but not with severe Patient Prosthesis Mismatch. CONCLUSION: Severe Patient Prosthesis Mismatch is more common in females, but not in those with minimal available body surface area. Though operative times were shorter in these patients, intensive care unit and hospital lengths of stay were longer. Surgeons and cardiologists should be cognizant of these clinical predictors and complications prior to valve surgery.
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Astudillo et al. (2012) conducted a cohort in Aortic stenosis (n=311). Severe Patient Prosthesis Mismatch vs. Nonsignificant Patient Prosthesis Mismatch was evaluated on In-hospital mortality. Severe patient prosthesis mismatch occurred in 16% of bioprosthetic aortic valve replacements, was more common in females, and was associated with 8% in-hospital mortality vs 2.3% for no mismatch.
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