Impact of prosthesis-patient mismatch on late outcomes after bioprosthetic mitral valve replacement for mitral regurgitation

Background and Aim of the Study: Negative impact of prosthesis-patient mismatch (PPM) on long term survival after valve replacement has been reported. However, the effect of PPM after bioprosthetic mitral valve replacement (MVR) has not yet been well examined. The purpose of this study was to investigate the effect of PPM on late outcomes after bioprosthetic MVR for mitral regurgitation (MR). Methods: A total of 181 patients underwent bioprosthetic MVR between April 2008 and December 2016. After excluding patients with mitral stenosis and those with incomplete data, 128 patients were included in the study. Postoperative transthoracic echocardiography was performed for all patients and the effective orifice area (EOA) was calculated using the pressure half-time method. The effective orifice area index (EOAI) was calculated by the formula: EOA/body surface area (BSA). PPM was defined as a postoperative EOAI ≤ 1.2 cm2/m2. The characteristics and outcomes were compared between the groups. Results: There were 34 patients (26.6%) with PPM and 94 patients (73.4%) without PPM. Although proportion of males and BSA were higher in the PPM group, valve size distributions were similar between the two groups. There were no significant differences in the in-hospital mortality and morbidities. Multivariable analysis showed that PPM was an independent predictor of late mortality (hazard ratio [HR] 3.38; 95% confidence interval [CI] 1.69-6.75; p = .001) and death from heart failure (HR 31.03, 95% CI 4.49-214.40, p < .001). Conclusions: PPM after MVR for MR was associated with long-term mortality and death from heart failure.

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Clinical, Echocardiographic, and Pathologic Features of Aortic Wall Dehiscence of Porcine Bioprosthetic Valves: A Cause of Rapidly Progressive Mitral Regurgitation and Heart Failure After Bioprosthetic Mitral Valve Replacement

Journal of the American Society of Echocardiography ◽

10.1053/je.1998.v11.a90296 ◽

1998 ◽

Vol 11 (7) ◽

pp. 720-728 ◽

Cited By ~ 5

Author(s):

Tasneem Z. Naqvi ◽

Robert J. Siegel ◽

Neil A. Buchbinder ◽

Michael C. Fishbein

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Aortic Wall ◽

Pathologic Features ◽

Bioprosthetic Valves ◽

Bioprosthetic Mitral Valve

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Mitral Valve Replacement in Patient with Absent Right Superior Vena Cava, Pectus Excavatum, Marfan Syndrome and Severe Mitral Regurgitation

Heart Lung and Circulation ◽

10.1016/j.hlc.2007.09.007 ◽

2008 ◽

Vol 17 (6) ◽

pp. 507-510

Author(s):

P. Singhal ◽

R. Ullal

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Marfan Syndrome ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Superior Vena Cava ◽

Pectus Excavatum ◽

Superior Vena ◽

Vena Cava ◽

Severe Mitral Regurgitation

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Effect of mitral valve replacement on left ventricular function in mitral regurgitation.

Heart ◽

10.1136/hrt.49.4.328 ◽

1983 ◽

Vol 49 (4) ◽

pp. 328-333 ◽

Cited By ~ 34

Author(s):

H V Huikuri

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Left Ventricular Function ◽

Ventricular Function ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Left Ventricular

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Surgery for Degenerative Mitral Regurgitation Valve Repair v. Valve Replacement with Chordal Preservation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239400200208 ◽

1994 ◽

Vol 2 (2) ◽

pp. 90-94

Author(s):

Masaharu Shigenobu ◽

Shunji Sano

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Left Ventricular Function ◽

Ventricular Function ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Mitral Valve Repair ◽

Left Ventricular ◽

Valve Repair ◽

Repair Group

This study compares mitral valve repair and mitral valve replacement with chordal preservation for chronic mitral regurgitation due to myxomatous degeneration with special reference to left ventricular function. Twenty-six patients underwent complete preoperative and 2 years later postoperative echocardiography study. Thirteen patients underwent mitral valve replacement associated with preservation of chordae tendineae and papillary muscles, and 13 patients had mitral valve repair. There were no statistically significant differences between the 2 groups for clinical findings, hemodynamic profiles, or left ventricular function compared prior to surgery. After correcting mitral regurgitation, increase in cardiac index was significant for the repair group. Left ventricular end-diastolic volume decreased in both groups. Left ventricular end-systolic volume significantly decreased in the repair group, but remained unchanged in the replacement group. Both ejection fraction and mean left ventricular circumferential fiber shortening velocity (mVcf) decreased in the replacement group, but significantly increased in the repair group 2 years after surgery. These findings suggest valve replacement with chordal preservation shows less improvement in ventricular systolic function late after surgery compared with mitral valve repair.

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A Giant Left Atrium due to Rheumatic Mitral Regurgitation, Outcome after Left Atrial Reduction Surgey with Mitral Valve Replacement

University Heart Journal ◽

10.3329/uhj.v14i1.38488 ◽

2018 ◽

Vol 14 (1) ◽

pp. 42-44

Author(s):

Istiaq Ahmed ◽

Sorower Hossain ◽

Ankan Kumar Paul

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Left Atrium ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Left Atrial ◽

Quick Recovery ◽

Replacement Surgery ◽

Atrial Size ◽

Giant Left Atrium

A trans-thoracic echocardiography and chest radiograph of a 26 year old lady diagnosed as rheumatic mitral regurgitation with atrial fibrillation revealed a giant left atrium of 10.9 cm size with symptoms of dyspnoea and palpitation. The patient was treated with left atrial size reduction along with mitral valve replacement surgery and showed an excellent and quick recovery with total disappearance of symptoms and restoration of sinus rhythm only within few days.University Heart Journal Vol. 14, No. 1, Jan 2018; 42-44

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Prediction of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation. The importance of left atrial size.

Circulation ◽

10.1161/01.cir.84.1.23 ◽

1991 ◽

Vol 84 (1) ◽

pp. 23-34 ◽

Cited By ~ 101

Author(s):

D Reed ◽

R D Abbott ◽

M L Smucker ◽

S Kaul

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Left Atrial ◽

Left Atrial Size ◽

Prediction Of Outcome ◽

Atrial Size

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Combined Mitral Valve Replacement and Pericardiectomy in a Patient with Mitral Regurgitation and Constrictive Pericarditis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239400200213 ◽

1994 ◽

Vol 2 (2) ◽

pp. 109-110

Author(s):

Nainar Madhu Sankar ◽

Premanand Ponoth ◽

Krishna Sivaprakasha ◽

John Bapoo Kotail Jacob ◽

Vellayikodath Velayudhan Bashi ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Postoperative Period ◽

Constrictive Pericarditis ◽

Inotropic Support ◽

Surgical Correction

We present the case of a patient with chronic constrictive pericarditis and significant mitral regurgitation who successfully underwent combined pericardiectomy and mitral valve replacement. The need for early surgical correction is stressed. Prolonged ventilatory and inotropic support was required in the postoperative period.

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