Influence of prosthesis-patient mismatch on left ventricular remodelling in severe aortic insufficiency

Abstract

Objective: The present study evaluates the impact of prosthesis-patient mismatch (PPM) on left ventricular remodelling following aortic valve replacement (AVR) for severe aortic insufficiency.

Methods: In this study, 230 patients undergoing aortic valve surgery were divided into two groups depending on whether or not they exhibited PPM. Postoperative left ventricular (LV) dimensions and function were compared to the preoperative status.

Results: The incidence of PPM (EOAi <or=0.85 cm(2) m(-2)) was 22.2%. There was no significant difference in the reduction of mean end-diastolic LV diameter (LVEDD; p=0.31) or mean end-systolic LV diameter (LVESD; p=0.79) between the non-PPM and the PPM groups. The LVEDD was reduced in the non-PPM group from 66+/-9 to 55+/-9 mm postoperatively (p<0.001) while the LVEDD in the PPM group was reduced from 65+/-9 to 56+/-10mm (p<0.001). The LVESD was reduced in the non-PPM group from 49+/-10 to 40+/-10mm postoperatively (p<0.001) while the LVESD in the PPM group was reduced from 50+/-11 to 39+/-10mm (p<0.001). Patients with preoperative LV dysfunction (ejection fraction (EF) <50%) demonstrated a significant improvement in postoperative LVEF in both the non-PPM (36+/-8% to 44+/-12%, p<0.001) and PPM groups (33+/-7% to 46+/-11%, p=0.001) but no significant difference could be demonstrated in the rate of improvement between the two groups (p=0.23). Furthermore, no significant difference was found in survival between patients with PPM and those without (p=0.23).

Conclusions: PPM did not influence left ventricular remodelling or survival following AVR for severe aortic insufficiency. The left ventricular remodelling process was initiated regardless of preoperative LVEF, and the impact of PPM seems to be of little importance.