on January 16, 2006
Published online before print January 16, 2006, doi: 10.1161/CIRCULATIONAHA.105.546754
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Submitted on March 2, 2005
From the Division of Cardiovascular Diseases (D.M.-E., J.F.M., S.E.G., M.E.E.-S., F.A.M.), the Division of Cardiovascular Surgery (H.V.S.), and the Division of Biostatistics (D.E.G.), Mayo Clinic, Rochester, Minn. * To whom correspondence should be addressed. E-mail: miller.fletcher{at}mayo.edu.
Background--The impact of aortic prosthesis-patient mismatch (P-PtM) on long-term survival is unclear. Methods and Results--Between 1985 and 2000, 388 patients at Mayo Clinic in Rochester, Minn, underwent aortic valve replacement (AVR) with 19- or 21-mm St Jude Medical prostheses and had transthoracic echocardiography within 1 year after AVR. Mean age of patients was 62±13 years; 69% were female. Prosthesis effective orifice area (EOA) was derived from the continuity equation. P-PtM was classified as severe (indexed EOA Conclusions--Severe P-PtM is an independent predictor of higher long-term mortality and congestive heart failure in patients with small St Jude Medical aortic valve prostheses. For patients undergoing AVR who are at risk of severe mismatch, every effort should be made to use a larger prosthesis or to consider a prosthesis with a larger EOA.
Revised on October 20, 2005
Accepted on October 27, 2005
Impact of Prosthesis-Patient Mismatch on Long-Term Survival in Patients With Small St Jude Medical Mechanical Prostheses in the Aortic Position
Dania Mohty-Echahidi MD,
0.60 cm2/m2), moderate (0.60 cm2/m2<indexed EOA0.85 cm2/m2), or not hemodynamically significant (indexed EOA >0.85 cm2/m2). P-PtM was severe in 66 patients (17%), moderate in 168 (43%), and not hemodynamically significant in 154 (40%). Patients with severe P-PtM had a significantly larger body surface area (P<0.0001), higher mean gradient (P<0.0001), lower preoperative (P<0.0001) and postoperative (P<0.0001) ejection fractions, and lower stroke volume (P<0.0001) and more often received a 19-mm prosthesis (P=0.0008) than patients with moderate or no hemodynamically significant mismatch. For patients with severe mismatch, 5-year survival rates (72±6%) and 8-year survival rates (41±8%) were significantly less than for patients with moderate mismatch (80±3% and 65±5%; P=0.026) or no hemodynamically significant mismatch (85±3% and 74±5%; P=0.002). On multivariate analysis after adjustment for other predictors of outcome, severe mismatch was associated with higher mortality (hazard ratio 2.18; 95% confidence interval 1.24 to 3.85; P=0.007) and higher incidence of congestive heart failure (hazard ratio 3.1; 95% confidence interval 1.3 to 7.4; P=0.009) than no hemodynamically significant mismatch.
Key words: prosthesis • aorta • survival • valves
Related Article:
Circulation 2006 113: 329.
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