Patient Prosthesis Mismatch in Mitral Position – a Myth or Reality

Anbarasu Mohanraj, Vijayanand Palanisamy, Saikumari Nagaraj, Rekha Arunagiri, Rajan Sethurathinam, Kurian M. Vallikapathalil

Madras Medical Mission, Chennai, India, Chennai, India

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–B

Abstract

Purpose:

Patient Prosthesis mismatch (PPM) in the mitral position and its effect on regression of Pulmonary arterial hypertension (PAH) remains unclear, unlike in the Aortic position where PPM is a very well recognized entity.

Methodology:

Patients who underwent Mitral valve replacement (MVR) between January 2014 and December 2015 were enrolled and analyzed serially by Echocardiography for Incidence of PPM after MVR and effect of PPM on post operative PAH and left atrial size regression.

Results:

153 patients underwent isolated MVR during the study period. Nine patients lost follow-up. The mean age of patients was 45.01+11.58yrs. Of the 144 patients who were enrolled, 64 (44.44%)patients had PPM with a mean EOAi of 1.07cm²/m². 61 patients (42.36%) had moderate PPM with a mean EOAi of 1.08 cm²/m². 3 patients (2.08%) had severe PPM with a mean EOAi of 0.86cm²/m². Size of valve implanted was smaller in PPM groups (26.23+1.4 vs 27.11+2.09 mm ; p<0.05). Persistence of post operative PAH was more in PPM group (40.6% vs 12.5%: p<0.000) Regression of left atrial size was statistically significant in Non PPM group (p<0.000) The mean gradient across the prosthetic valve was significantly higher among the PPM group (4.73+2.18 vs 3.46+ 1.2 mm Hg: p<0.000)

Conclusion:

PPM does exist in the Mitral position with its own adverse effects such as hindered regression of LA size and PA pressures.