Association between severe patient-prosthesis mismatch and prosthetic valve dysfunction following aortic valve replacement surgery with a biological prosthesis

MARIANA MAHIA; MARIA TERESA POLITI; RICARDO RONDEROS; AGUSTINA SCIANCALEPORE; GUSTAVO AVEGLIANO; JUAN MARIANO VRANCIC; MARIANO CAMPORROTONDO; FERNANDO PICCININI; DANIEL NAVIA

Munich

Congreso; European Society of Cardiology Annual Congress; 2018

European Society of Cardiology

Background: Patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) surgery with a biological prosthesis may limit left ventricle reverse remodeling and mass regression; however it's effect on the valve's hemodynamic profile and prosthetic valve dysfunction still remains controversial.Purpose: To evaluate the association between severe PPM and prosthetic valve dysfunction following AVR surgery with a biological prosthesis.Methods: In a retrospective observational study, adult patients who were followed after an AVR surgery with a biological prosthesis at our center were assessed for enrollment. Patients with incomplete demographic, surgical, or imaging data (at least one complete Doppler echocardiography evaluation within the first 60 postoperative (POP) days) were excluded. Patients were classified into three groups according to the effective orifice area indexed to total body surface measured within the first 60 POP days: severe mismatch (≤0.65 cm2/m2), moderate mismatch (between 0.85 and >0.65 cm2/m2) and no mismatch (>0.85 cm2/m2). Patients with moderate mismatch were excluded. Prosthetic valve dysfunction was defined as the presence of thrombosis, pannus or valve degeneration detected during follow-up. All tests used STATA v15.Results: Between January 2003 and June 2017, 223 patients were followed-up after AVR surgery with a biological prosthesis at our center; 38 were excluded due to lack of complete imaging data, 68 were excluded due to moderate mismatch. A total of 117 patients were enrolled: 72 with severe PPM and 45 without PPM. Overall, patients' baseline characteristics were similar among groups. Patients were mostly elder (69.0±10.3 vs 68.2±6.1 years-old), males (61.1% vs 55.6%) with degenerative aortic valves (79.1% vs 66.7%). Within the first 6 POP weeks, both mean (25.3±1.2 vs 13.7±0.8 mmHg; p