Effects of patient-prosthesis mismatch on postoperative early mortality in isolated aortic stenosis
Journal of Heart Valve Disease, cilt.18, sa.1, ss.18-27, 2009 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 18 Sayı: 1
- Basım Tarihi: 2009
- Dergi Adı: Journal of Heart Valve Disease
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.18-27
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background and aim of the study: Small valve size and patient-prosthesis mismatch (PPM) generate high postoperative transvalvular gradients and may decrease both early and long-term survival. The study aim was to evaluate whether mismatch affect-ed early mortality after aortic valve replacement (AVR) for isolated aortic stenosis (AS). Methods: A total of 701 patients (437 males, 264 females; mean age 53.3 ± 15.1 years; range: 14-84 years) with pure AS underwent AVR at the authors' institution between 1985 and 2005. The majority of patients (92%) received a mechanical valve. PPM was considered severe if the indexed effective orifice area was ≤0.65 cm2/m2, and moderate if >0.65 but ≤0.85 cm2/m2. Results: Moderate-severe PPM was present in 47% of patients, and severe PPM in 13%. The early mortality was 5.4% (n = 38). Multivariate analysis revealed age ≥70 years (p <0.001), female gender (p = 0.04) and severe PPM (p = 0.003) as independent predictors of early mortality. Moderate mismatch was not a predic-tor of early mortality on both univariate and multi-variate analysis. Left ventricular dysfunction (ejection fraction ≤40%) was a risk factor for early mortality only in patients with severe PPM. Conclusion: Patient-prosthesis mismatch should be prevented in patients undergoing AVR for isolated AS, especially in those with left ventricular dysfunction. © Copyright by ICR Publishers 2009.