Effect of Valve Prosthesis-Patient Mismatch on Left Ventricular Mass Regression Following Aortic Valve Replacement

Hosam F. Fawzy ¹, Mostafa Eissa ¹, Abdel Hadi Taha ¹, Ehab Wahby ¹, Dante Medici ²

¹ Faculty of Medicine, University of Tanta, Tanta, Egypt; ² Cardio-Thoracic and vascular department, Azienda Sanitaria , Santi Antonio e Biagio- Alessandria, Italy;

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–B

Abstract

Objective:

Valve prosthesis-patient mismatch after aortioc valve replacement (AVR) for Aortic stenosis, is a frequent problem that may delay the expected left ventricular hypertrophy regression. The aim of this work was to study the effect of prosthesis-patient mismatch on the postoperative regression of left ventricular mass after aortic valve replacement.

Patients and Methods:

Left ventricular mass (LVM) was measured by Doppler echocardiography in 80 patients undergoing aortic valve replacement using(Medtronic Mosaic biological valve) for pure aortic stenosiswith no more than mild aortic valve incompetence.The majority were females (69%), aged 56-88 years, with a mean of(77.48±7.46) years.Prosthesis- patient mismatch was defined as an indexed effective orifice area (IEOA) less than 0.85 cm²/m². On this basis, 20/80 (25%) patients had prosthesis-patient mismatch.

Results:

With the increased IEOA there was a significant decrease in the Trans prosthetic gradient (p =0.0001, r =0.395); and consequently significant increase in rate of regression in the LV mass after six months.However, the left ventricular mass regression was significantly lower in patients with prosthesis-patient mismatch (- 100 g, - 19%) compared to those with no prosthesis-patient mismatch (- 176 g, - 32%) (p= 0.025). In multivariate analysis, systemic hypertension, higher preoperative left ventricular mass index≥ 250 g/m² andhigher preoperative NYHA class> IIwere independent predictors of lower left ventricular mass regression.

Conclusion:

Patients with pure aortic stenosis who develop prosthesis-patient mismatch after aortic valve replacement are associated with lesser regression of left ventricular mass.These findings may have important clinical implications in predicting the prosthesis-patient mismatch preoperatively and developing a strategy to avoid that post-operatively.