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dc.contributor.authorShi, William Yen
dc.contributor.authorYap, Cheng-Honen
dc.contributor.authorHayward, Philip A Ren
dc.contributor.authorDinh, Diem Ten
dc.contributor.authorReid, Christopher Men
dc.contributor.authorShardey, Gilbert Cen
dc.contributor.authorSmith, Julian Aen
dc.identifier.citationHeart (british Cardiac Society) 2011; 97(13): 1074-81en
dc.description.abstractProsthesis-patient mismatch (PPM) is characterised by the effects of inadequate prosthesis size relative to body surface area (BSA). It is uncertain whether PPM after mitral valve replacement impacts upon clinical outcome. This was examined in an Australian population.From 2001 to 2009, 1006 mechanical and bioprosthetic mitral valves were implanted across 10 institutions. Effective orifice areas (EOA) were obtained from a literature review of in vivo echocardiographic data. Absent, moderate and severe PPM was defined as an indexed EOA (EOA/BSA) of >1.20 cm(2)/m(2), >0.90 to ≤1.20 cm(2)/m(2) and ≤0.9 cm(2)/m(2), respectively. Early outcomes and 7-year survival were compared between these three groups.PPM was absent in 34%, moderate in 53% and severe in 13% of patients. Patients with PPM were more likely to be male (42% vs 52% vs 62%, p<0.0001) and obese (14% vs 20% vs 56%, p<0.0001). Postoperatively there was similar 30-day mortality (5% vs 5% vs 6%, p=0.83) and early any mortality/morbidity (24% vs 27% vs 29%, p=0.40). Seven-year survival was similar between groups (72±4.1% vs 76±3.2% vs 69±10.3%, p=0.76). PPM did not predict adverse events after logistic and Cox regressions with and without propensity score adjustment. Subgroup analyses of those with isolated mitral valve surgery, patients with preoperative congestive heart failure and non-obese patients failed to show an association between PPM and mid-term mortality.Overall, PPM was not associated with poorer early outcomes or mid-term survival. Oversizing valves may be technically hazardous and do not yield superior outcomes. Easier implantation by appropriate sizing appears justified.en
dc.subject.otherEpidemiologic Methodsen
dc.subject.otherHeart Valve Diseases.mortality.surgeryen
dc.subject.otherHeart Valve Prosthesis.adverse effectsen
dc.subject.otherHeart Valve Prosthesis Implantation.adverse effects.instrumentation.mortalityen
dc.subject.otherMiddle Ageden
dc.subject.otherMitral Valve.surgeryen
dc.subject.otherProsthesis Designen
dc.subject.otherProsthesis Fittingen
dc.subject.otherTreatment Outcomeen
dc.titleImpact of prosthesis--patient mismatch after mitral valve replacement: a multicentre analysis of early outcomes and mid-term survival.en
dc.typeJournal Articleen
dc.identifier.journaltitleHeart (British Cardiac Society)en
dc.identifier.affiliationDepartment of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australiaen
dc.type.austinJournal Articleen
item.fulltextNo Fulltext-
item.openairetypeJournal Article-
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