Prosthesis–patient mismatch due to small ring annuloplasty in patients with degenerative mitral insufficiency

• Published in: Journal of cardiology 2016-08, Vol.68 (2), p.141-147
• Main Authors: Kawamoto, Naonori, MD, Fujita, Tomoyuki, MD, PhD, Hata, Hiroki, MD, PhD, Shimahara, Yusuke, MD, Sato, Shunsuke, MD, Kobayashi, Junjiro, MD, PhD, FJCC
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cardiovascular; Echocardiography; Female; Follow-Up Studies; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve - physiopathology; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Mitral valve repair; Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Period; Prosthesis–patient mismatch; Retrospective Studies; Ring annuloplasty; Risk Factors; Treatment Outcome; Tricuspid Valve - physiopathology
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2015.09.007

Abstract Background Avoidance of prosthesis–patient mismatch (PPM) is important when selecting a mitral valve prosthesis. This study investigated the effect of PPM after small ring mitral valve annuloplasty on postoperative hemodynamics and the clinical course. Methods This study retrospectively reviewed 227 patients with symptomatic severe mitral insufficiency (MI) who underwent mitral valve repair for degenerative MI using an Edwards ring or band (size: 26–32 mm) between 2003 and 2012. Echocardiography was performed postoperatively and at follow-up to evaluate cardiac function, including residual MI, mean transmitral pressure gradient, left atrial diameter (LAD), and tricuspid regurgitant pressure gradient (TRPG). Results There were no operative deaths. Actuarial freedom from major adverse cardiac events was 91% at 10 years. The postoperative MI grade was not significantly different between different sizes of prosthesis (26 mm, 0.67 ± 0.8; 28 mm, 0.73 ± 0.9; 30 mm, 0.85 ± 0.9; 32 mm, 0.3 ± 0.6). LAD and TRPG were significantly lower for each size of prosthesis at follow-up (all p < 0.05). Patients with a smaller body surface area received a significantly smaller prosthesis ( p < 0.05). The transmitral pressure gradient was significantly higher in patients with a 26-mm prosthesis than in patients with a larger size of prosthesis. Thirty-three patients had a follow-up transmitral pressure gradient ≥5 mmHg. The follow-up LAD was larger in patients with a transmitral pressure gradient