Document Detail

Factors affecting survival after mitral valve replacement in patients with prosthesis-patient mismatch.
MedLine Citation:
PMID:  20868815     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The purpose of this study was to determine the impact of prosthesis-patient mismatch on long-term survival after mitral valve replacement.
METHODS: From 1992 to 2008, 765 patients underwent bioprosthetic (325; 42%) or mechanical (440; 58%) mitral valve replacement, including 370 (48%) patients older than 65 years of age. Prosthesis-patient mismatch was defined as severe (prosthetic effective orifice area to body surface area ratio <0.9 cm(2)/m(2)), moderate (0.9 to 1.2 cm(2)/m(2)), or absent (>1.2 cm(2)/m(2)).
RESULTS: Multivariate analysis identified nine risk factors for late death including advanced age, earlier operative year, chronic renal insufficiency, peripheral vascular disease, congestive heart failure, nonrheumatic origin, concomitant coronary artery bypass grafting, lower body surface area, and more severe prosthesis-patient mismatch (lower effective orifice area to body surface area ratio; p < 0.05). For bioprosthetic recipients older than 65 years of age, survival at 5 and 10 years was 30% ± 7% and 0% ± 0% with severe mismatch compared with 43% ± 4% and 21% ± 5% for absent or moderate mismatch, respectively (p = 0.05). For mechanical recipients younger than 65 years of age, survival at 5 and 10 years was 77% ± 4% and 62% ± 6% with moderate or severe mismatch compared with 82% ± 3% and 66% ± 4%, respectively, without mismatch (p = 0.08).
CONCLUSIONS: Severe mismatch adversely affected long-term survival for older patients receiving bioprosthetic valves. With mechanical valves, there was a trend toward impaired survival when mismatch was moderate or severe in younger patients. Thus, selection of an appropriate mitral prosthesis warrants careful consideration of age and valve type.
Abdulhameed Aziz; Jennifer S Lawton; Hersh S Maniar; Michael K Pasque; Ralph J Damiano; Marc R Moon
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2010-10-21     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1202-10; discussion 1210-1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Heart Valve Diseases / etiology,  surgery*
Heart Valve Prosthesis*
Heart Valve Prosthesis Implantation / mortality*
Middle Aged
Mitral Valve / surgery*
Multivariate Analysis
Patient Selection
Risk Factors
Survival Analysis
Treatment Outcome
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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