• Cheng-Hon Yap, Morteza Mohajeri, and Michael Yii.
• Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria 3065, Australia. Cheng-Hon.YAP@svhm.org.au
• Heart Lung Circ. 2007 Aug 1; 16 (4): 260-4.

BackgroundProsthesis-patient mismatch (PPM) occurs when the valve prosthesis implanted at surgery is too small in relation to patient's body size, causing high transvalvular gradients. We investigated if severe PPM is related to early morbidity and mortality after aortic valve replacement (AVR).MethodsWe analysed prospectively collected data of 701 consecutive patients undergoing AVR between June 2001 and February 2006 at two Australian public hospitals. The indexed valve effective orifice area (IEOA) was estimated for each valve prosthesis implanted. PPM was defined as ResultsPPM was present in 6.6% of patients. Overall operative mortality was 4.1%. Isolated AVR was performed in only 38.4% of patients. For patients with PPM, the univariate and multivariate odds ratio for mortality were 5.2 (P=0.002) and 6.1 (P=0.006), respectively. The other multivariate predictors of mortality were age, pre-operative serum creatinine, emergency status, pulmonary artery pressure and bypass time. PPM was not associated with stroke, prolonged ventilation, new renal failure, prolonged intensive care or hospital stay, or readmission within 30 days.ConclusionPPM was associated with increased operative mortality. PPM should be avoided where possible as it may reduce operative mortality following AVR.

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