Impact of Prosthesis-Patient Mismatch on the Regression of Secondary Mitral Regurgitation After Isolated Aortic Valve Replacement With a Bioprosthetic Valve in Patients With Severe Aortic Stenosis

Abstract

Background-Secondary mitral regurgitation (SMR) is generally reduced after isolated aortic valve replacement (AVR), but there is important interindividual variability in the magnitude of this reduction. Prosthesis-patient mismatch (PPM) may hinder normalization of left ventricular geometry and pressure overload following AVR, therefore we aimed to investigate the relationship between PPM and regression of SMR following AVR for aortic valve stenosis. Methods and Results-A total of 419 patients with AS who underwent isolated AVR at 2 institutions and presenting moderate SMR (mitral regurgitant volume 30 to 45 mL/beat) not considered for surgical correction were included in this study. Clinical and echocardiographic follow-up were completed at a median follow-up time of 37 months. PPM was defined as an indexed effective orifice area Յ0.85 cm 2 /m 2 and was found in 170/419 patients (40.6%). There were no significant differences in baseline and operative characteristics between patients with or without PPM. Patients with PPM had less regression of SMR following AVR compared with those with no PPM (change in mitral regurgitant volume:Ϫ11Ϯ4 versus Ϫ17Ϯ5 mL, respectively; PϽ0.0001). Variables significantly associated with postoperative change in mitral regurgitant volume on univariable analysis were entered in a multivariable linear regression model, which showed indexed effective orifice area (PϽ0.0001) and left atrial diameter (Pϭ0.006) to be independently associated with mitral regurgitant volume improvement. Patients with PPM also had less postoperative improvement in 6-minute walking test distance (80Ϯ78 versus 42Ϯ41 m, PϽ0.0001). Conclusions-PPM is associated with lesser regression of SMR following AVR. This unfavorable effect was associated with worse functional capacity. These findings emphasize the importance of operative strategies aiming to prevent PPM in patients with aortic valve stenosis and concomitant SMR. (Circ Cardiovasc Imaging. 2012;5:36-42.)

Impact of Mitral Regurgitation on Clinical Outcomes After Transcatheter Aortic Valve Implantation

“…3 32 The presence of prosthesis-patient mismatch leads to a residual gradient across the aortic valve and has been shown to be associated with a lesser regression of coexistant MR after SAVR. [49][50] TAVI is associated with lower rates of prosthesis-patient mismatch and whether this translates into differences in MR improvement as compared with SAVR remains to be seen. 51…”

Impact of prosthesis-patient mismatch on long-term results of aortic valve replacement

“…Несмотря на то что умеренная и тяжелая степень РРМ, по данным литературы [8,10], развивается у 20-70% больных после ПАК, в настоящее время влияние данного феномена на отдаленные послеоперационные результаты остается неоднозначным. Некоторые авторы [2,7,15,19] указывают на меньшую выживаемость среди пациентов с РРМ, обусловленную, вероятно, худшим ремоделированием ЛЖ, другие исследователи [6,9,16,17] не наблюдают значительного влияния РРМ на результаты лечения.…”

Reverse myocardial remodeling in patients with aortic valve disease and mitral insufficiency in early postoperative period

“…Ряд исследований показывают, что стойкая митральная недостаточность в послеоперационном периоде у больных после изолированного протезирования аортального клапана сопровождается большей частотой сердечной недостаточности и летальных исходов. Степень митральной регургитации, как правило, уменьшается после коррекции аортального порока, но этот процесс также зависит от ряда дополнительных гемодинамических параметров [31,37,38], в частности показано, что развитие феномена prosthesis-patient mismatch у больных после протезирования аортального клапана замедляет обратное ремоделирование миокарда и ограничивает вероятность снижения митральной недостаточности [14].…”