Prosthesis-patient Mismatch - What Cardiac Anesthesiologists Need to Know?
OBJECTIVE To investigate the mid-long-term clinical results of aortic valve replacement with 17 mm St. Jude medical regent valve with hemodynamic evaluation including the measurement of effective orifice area, the occurrence of prosthesis-patient mismatch (PPM) and its affect on heart function. METHODS There were 44 patients accepted aortic valve replacement with 17 mm St. Jude medical regent valve because of small aortic annulus. Before the operation and during the postoperative follow-up, color doppler echocardiography was used to measure the hemodynamic parameters, such as left ventricular mass (LVmass), effective orifice area (EOA) and effective orifice area index (EOAI), etc. RESULTS Transthoracic echocardiographic data were obtained from 39 of 44 patients (88.6%) at 12-55 months after surgery. One (2.27%) died of heart failure in 1 year. According to the current standard of PPM (EOAI < or = 0.85 cm2/m2), 33 cases (82.1%) had PPM, 13 cases (30.8%) had severe PPM with an EOAI < or = 0.65 cm2/m2. After the operation, there were significant decreases in LVAo-PG (19 +/- 8) mmHg and left ventricular mass index (LVmass I) (86.6 +/- 23.3) g/m2 (P < 0.05). The assessment for physical capacity according to NYHA classification: 41 patients improved to class II or better and 2 patients improved to class III (P < 0.05). CONCLUSION The patients with small aortic annulus may obtain satisfactory clinical results after AVR with 17 mm St. Jude medical regent valve, PPM seems not affect the mid-long-term results.