Mannacio Vito A, Mannacio Luigi, Antignano Anita, Pinna Giovanni B, Giordano Raffaele, Mottola Michele, Iannelli Gabriele
aDepartment of Cardiac Surgery, University Federico II, School of Medicine bDepartment of Cardiology, Azienda Ospedaliera Santobono-Pausillipon, Naples, Italy.
J Cardiovasc Med (Hagerstown). 2017 May;18(5):366-373. doi: 10.2459/JCM.0000000000000508.
Mortality and left ventricular mass (LVM) recovery/regression after aortic valve replacement in patients with prosthesis-patient mismatch (PPM) is controversial. This study evaluated the impact of different values of indexed effective orifice area (EOAi) in male patients on mortality and indexed LVM (ILVM) recovery/regression.
The study recruited 376 male patients with and without PPM after aortic valve replacement with different EOAi cut-off values.
At EOAi 0.85 cm/m or less, 295 patients had PPM (78.5%). ILVM recovery occurred in 60.5% of no-PPM patients versus 46.1% of patients with PPM (P = 0.003), and ILVM regression was 35 versus 25% (P < 0.001). Time for ILVM regression was shorter in no-PPM group. At EOAi 0.75 cm/m or less, 201 patients had PPM (53.4%). ILVM recovery occurred in 55.4% of no-PPM patients versus 45.2% of patients with PPM (P = 0.06), regression was 32 versus 29% (P = 0.09). Time for ILVM regression was similar between groups. Regardless the cut-off value for PPM definition, mortality was similar.
LVM recovery/regression, but not mortality, was different at different EOAi. The cut-off value at EOAi 0.75 cm/m or less guaranteed a more balanced patient distribution between groups and the best compromise between specificity and sensitivity.
