Yonsei Med J.  2016 Mar;57(2):328-336. 10.3349/ymj.2016.57.2.328.

Prosthesis-Patient Mismatch after Mitral Valve Replacement: Comparison of Different Methods of Effective Orifice Area Calculation

• Cho IJ
• Hong GR
• Lee SH
• Lee S
• Chang BC
• Shim CY
• Chang HJ
• Ha JW
• Chung N

• KMID: 2374036
• DOI: http://doi.org/10.3349/ymj.2016.57.2.328

Abstract

PURPOSE
The incidence of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) has been reported to vary. The purpose of the current study was to investigate incidence of PPM according to the different methods of calculating effective orifice area (EOA), including the continuity equation (CE), pressure half time (PHT) method and use of reference EOA, and to compare these with various echocardiographic variables.
MATERIALS AND METHODS
We retrospectively reviewed 166 individuals who received isolated MVR due to rheumatic mitral stenosis and had postoperative echocardiography performed between 12 and 60 months after MVR. EOA was determined by CE (EOA(CE)) and PHT using Doppler echocardiography. Reference EOA was determined from the literature or values offered by the manufacturer. Indexed EOA was used to define PPM as present if < or =1.2 cm2/m2.
RESULTS
Prevalence of PPM was different depending on the methods used to calculate EOA, ranging from 7% in PHT method to 49% in referred EOA method to 62% in CE methods. The intraclass correlation coefficient was low between the methods. PPM was associated with raised trans-prosthetic pressure, only when calculated by CE (p=0.021). Indexed EOA(CE) was the only predictor of postoperative systolic pulmonary artery (PA) pressure, even after adjusting for age, preoperative systolic PA pressure and postoperative left atrial volume index (p<0.001).
CONCLUSION
Prevalence of mitral PPM varied according to the methods used to calculate EOA in patients with mitral stenosis after MVR. Among the various methods used to define PPM, EOA(CE) was the only predictor of postoperative hemodynamic parameters.

Keyword

Mitral valve; heart valve prosthesis

MeSH Terms

Adult
Aged
Echocardiography
Echocardiography, Doppler
Female
Heart Valve Diseases/*surgery
*Heart Valve Prosthesis
Heart Valve Prosthesis Implantation/*adverse effects/methods
Hemodynamics
Humans
Incidence
Male
Middle Aged
Mitral Valve/physiopathology/*surgery
Prevalence
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 Prevalence of PPM according to the methods used to calculate effective orifice area. PPM, prosthesis-patient mismatch; EOAICE, measured effective orifice area index by continuity equation; EOAIPHT, measured effective orifice area index by pressure half time; EOAIR, referred effective orifice area index.

• 

  Fig. 2 Correlation between EOAICE and EOAIPHT (A), between EOAICE and EOAIR (B) and between EOAIPHT and EOAIR (C). EOAICE, measured effective orifice area index by continuity equation; EOAIPHT, measured effective orifice area index by pressure half time; EOAIR, referred effective orifice area index.

• 

  Fig. 3 Correlations between effective orifice area index and postoperative systolic PA pressure. (A) Effective orifice area index by continuity equation, (B) effective orifice area index by pressure half time, and (C) referred effective orifice area index. PA, pulmonary artery; EOAICE, measured effective orifice area index by continuity equation; EOAIPHT, measured effective orifice area index by pressure half time; EOAIR, referred effective orifice area index.

• 

  Fig. 4 Comparison of postoperative systolic PA pressure among patients without PPM (n=63) to those with moderate PPM (n=80) and with severe PPM (n=23), defined using the continuity equation. Vertical bars represent range, boxes represent inter-quartile range, and horizontal lines represent the median. PPM, prosthesis-patient mismatch; PA, pulmonary artery.

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