Original articleAdult cardiacEffect of Prosthesis-Patient Mismatch on Long-Term Survival With Aortic Valve Replacement: Assessment to 15 Years
Section snippets
Patients and Methods
This is a retrospective study of prospectively collected data from the University of British Columbia Cardiac Valve Database. The database receives annual renewal from the University of British Columbia Clinical Research Ethics Board, which has a formal informed consenting process of patients.
From 1982 to 2003, 3,343 patients had aortic valve replacements at the affiliated teaching hospitals (St. Paul's Hospital, Vancouver General Hospital, and Royal Columbian Hospital) of the University of
Results
Of the total population of 3,343 patients, 1,547 (46.3%) had nonsignificant PPM, 1,584 (47.4%) had mild-to-moderate PPM, and 212 (6.3%) had severe PPM. The mean follow-up was 6.2 ± 5.0 years. During follow-up, 1,050 (31.4%) died: early mortality, 114 (3.4% [BP 4.0% (99), MP 1.8% (15)]; p = 0.002); late mortality, 1,050 (31.8%); cardiac-related mortality, 419 (12.5%); and valve-related mortality, 190 (5.7%). The early mortality for nonsignificant/normal PPM patients (PPM group A) was 3.4% (52);
Comment
The considered opinion of the hemodynamic consequence of prosthesis-patient mismatch is increased transvalvular gradients after aortic valve replacement and delay of regression of left ventricular hypertrophy and predictor of survival. There is considerable evidence that severe and (possibly) moderate PPM has a detrimental influence on early and late mortality [2, 3, 4, 5, 6, 7, 8].
The predominant investigators in the area of prosthesis-patient mismatch have been Pibarot and Dumesnil, with
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