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Impact of prosthesis-patient mismatch after mitral valve replacement in rheumatic population: Does mitral position prosthesis-patient mismatch really exist?

Authors
 Seung Hyun Lee  ;  Byung Chul Chang  ;  Young-Nam Youn  ;  Hyun Chel Joo  ;  Kyung-Jong Yoo  ;  Sak Lee 
Citation
 Journal of Cardiothoracic Surgery, Vol.12(1) : 88, 2017 
Journal Title
 Journal of Cardiothoracic Surgery 
Issue Date
2017
MeSH
Balloon Valvuloplasty/adverse effects* ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Heart Valve Prosthesis/adverse effects* ; Humans ; Incidence ; Male ; Middle Aged ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery* ; Mitral Valve Insufficiency/diagnosis ; Mitral Valve Insufficiency/etiology ; Mitral Valve Insufficiency/surgery* ; Postoperative Complications/epidemiology* ; Prosthesis Design ; Prosthesis Failure ; Republic of Korea/epidemiology ; Retrospective Studies ; Rheumatic Heart Disease/complications* ; Rheumatic Heart Disease/epidemiology ; Survival Rate/trends ; Time Factors ; Treatment Outcome
Keywords
Heart valve prosthesis ; Hemodynamics ; Mitral valve ; Mortality ; Surgery ; Valves
Abstract
BACKGROUND: Prosthesis-patient mismatch (PPM) is characterised by the effects of inadequate prosthesis size relative to body surface area (BSA).The purpose of this study was to determine the impact of PPM on late clinical outcomes after mitral valve replacement (MVR) in rheumatic population. METHODS: From 2000 to 2013, a total of 445 patients (mean age 54.2 ± 11.7 years) underwent isolated MVR (±tricuspid annuloplasty) for rheumatic disease were investigated. Effective orifice area (EOA) was determined by the continuity equation and PPM was defined as indexed EOA (EOA/BSA) ≤ 1.2 cm2/m2. Clinical and echocardiographic follow-up (mean follow up 8.7 ± 4.0 years) results were compared. RESULTS: 37% of patients (n = 165) had PPM. There were no significant differences in baseline and operative characteristics between patients with and without PPM except age and IEOA. A significant decrease in mean trans-valvular pressure gradient (MPG) over time following MVR, however the change of MPG showed no differences between groups (No PPM vs. PPM: 8.9 ± 4.7 mmHg → 3.6 ± 1.2 mmHg vs. 8.7 ± 4.5 mmHg → 3.8 ± 1.4 mmHg, p-value = 0.28). In all patients, there was a reduction of left atrium dimension (58.6 ± 12.0 mm → 53.2 ± 12.0 mm vs. 57.9 ± 8.9 mm → 52.2 ± 8.9 mm, p-value = 0.68) and left ventricular end diastolic diameter (49.9 ± 5.7 mm → 48.9 ± 5.7 mm vs. 49.7 ± 6.0 mm → 48.3 ± 5.0 mm, p = 0.24) without statistical significance. Freedom from TR progression rates at 3 and 5 years (99% vs.98%, 99% vs. 98%, p-value = 0.1), and overall survival rates at 3 and 5 years (97% vs. 96%, 94% vs. 94%, p-value = 0.7) were similar. CONCLUSION: This study shows that mitral PPM is not associated with atrial /ventricular remodeling and might not influence late clinical outcome including late TR progression, survival in rheumatic population.
Files in This Item:
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DOI
10.1186/s13019-017-0653-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
유경종(Yoo, Kyung Jong) ORCID logo https://orcid.org/0000-0002-9858-140X
윤영남(Youn, Young Nam)
이삭(Lee, Sak) ORCID logo https://orcid.org/0000-0001-6130-2342
이승현(Lee, Seung Hyun) ORCID logo https://orcid.org/0000-0002-0311-6565
장병철(Chang, Byung Chul)
주현철(Joo, Hyun Chel) ORCID logo https://orcid.org/0000-0002-6842-2942
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/161239
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