Hemodynamically significant prosthesis-patient mismatch can be predicted and is associated with early prosthetic valve dysfunction in aortic bioprosthesis

RONDEROS, RICARDO; POLITI, MARÍA TERESA; MAHIA, MARIANA CECILIA; CASTRO, MARÍA FLORENCIA; SCIANCALEPORE, AGUSTINA; CUEVA TORRES, FRANKLIN; KUSCHNIR, PAOLA; DE LA PAZ RICAPITO, MARÍA; VRANCIC, JUAN MARIANO; CAMPORROTONDO, MARIANO; PICCININI, FERNANDO; NAVIA, DANIEL

ECHOCARDIOGRAPHY (MOUNT KISCO, N.Y.)

WILEY-BLACKWELL PUBLISHING, INC

Año: 2021 vol. 38 p. 814 - 824

0742-2822

Objectives: To evaluate the accuracy of predicted prosthesis-patient mismatch (PPM) regarding actual PPM measured postoperatively. To assess the association between PPM and prosthetic valve dysfunction. Methods: Retrospective cohort study including adult patients after aortic valve replacement surgery with a biological prosthesis. Predicted PPM status was determined using mean reference effective orifice area indexed to total body surface (iEOA), without considering reference standard deviations. Postoperative PPM status was determined by measuring iEOA within the first 60 postoperative days. Prosthetic valve dysfunction was defined as thrombosis, pannus, valve degeneration, and/or disruption. Results: 205 patients were enrolled between January 2003 and June 2017: predicted PPM was absent in 52 patients (25.4%), moderate in 137 patients (66.8%), and severe in 16 patients (7.8%). After surgery, the actual postoperative iEOA was measured: 53 (25.9%) did not have PPM, 73 had moderate PPM (35.6%), and 79 had severe PPM (38.5%). Predicted PPM identified the presence of hemodynamically significant actual postoperative PPM (OR = 2.56; 95%CI 1.30?5.05; P =.006), though not its degree of severity. Prosthetic valve dysfunction was more frequent among patients with hemodynamically significant PPM (53.9% vs. 11.3%; P