Impact Of Effective Orifice Area Index Of Mitral Valve Prosthesis On Postoperative Pulmonary Artery Pressure And Functional Tricuspid Valve Regurgitation

Background: One of the common complications following mitral valve replacement is patient-prothesis mismatch. This problem can lead to unfavorable consequences that mimic residual mitral stenosis. Aim of the present study: Evaluating the incidence of patient-prosthesis mismatch, its associated predictors, and how it can influence the pulmonary hypertension and late tricuspid valve regurge. Methods: From September 2020 to December 2022, 100 consecutive patients (75 females), underwent MVR. The mean age was 46.78±9.59 years and mean EF was 61.84±7.68 %. The patients were divided according to the EOAI into: non-mismatch group (54%), moderate mismatch group (32%) and severe mismatch group (14%). Results: Patient-prosthesis mismatch diagnosed in 46% of the patients after MVR. They were divided into moderate mismatch group (32%) with mean EOAI was 1.04±0.08 cm2/M2 and severe mismatch group (14%) with mean EOAI was 0.75±0.09 cm2/M2. There was significant statistical difference in the size of implanted prostheses (P=0.023) with size 25 and 27 accounted for 58.6% of the implanted prostheses in mismatch groups. The univariate and multivariate analyses of the post-operatively inadequate regression of mean pulmonary artery pressure and deterioration of tricuspid valve regurgitation revealed that the EOAI was the only predictive factor [(OR=0.113, P=0.047), (OR=0.052, P=0.040), respectively]. Conclusion: The results revealed high incidence of mitral valve prosthesis mismatch in our patients. Also, they support that mitral PPM may prohibit the amelioration of both functional TR and PH in patients undergoing isolated MVR. MVR; Patient prosthesis mismatch; Effective orifice area; Functional tricuspid regurgitation; pulmonary artery pressure.