Prosthesis–patient mismatch due to small ring annuloplasty in patients with degenerative mitral insufficiency. Issue 2 (August 2016)

• Record Type: Journal Article
• Authors: Kawamoto, Naonori; Fujita, Tomoyuki; Hata, Hiroki; Shimahara, Yusuke; Sato, Shunsuke; Kobayashi, Junjiro
• Is Part Of: Journal of cardiology. Volume 68:Issue 2(2016:Aug.)
• Page Start: 141
• Page End: 147
• Publication Date: 2016-08
• Subjects: Prosthesis–patient mismatch -- Mitral valve repair -- Ring annuloplasty; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2015.09.007
• Languages: English
• ISSNs: 0914-5087

Abstract

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 <5 mmHg than in patients with that ≥5 mmHg (43.2 ± 9.4 mm vs 47.1 ± 9.6 mm, p < 0.05). Conclusions: Mitral valve repair results in excellent clinical outcomes with significant reductions in MI, LAD, and TRPG for all sizes of prosthesis. However, use of a smaller prosthesis may result in a higher mean transmitral pressure gradient, and may inhibit reverse remodeling of the left atrium. Therefore, PPM should be avoided.