Patient prosthesis mismatch after aortic valve replacement: An Indian perspective

CONTEXT: Perioperative period. AIMS: Occurrence of PPM after AVR, factors associated with PPM, impact on mortality. SETTINGS AND DESIGN: Teritary Care Referral Cardiac Centre. MATERIALS AND METHODS: A retrospective analysis of AVR procedures at a single centre over 4 years was conducted. Demographic, echocardiographic and outcome data were collected from institute database. Rahimtoola criteria of indexed effective orifice area (iEOA) were used to stratify patients into PPM categories. Patients with and without PPM were compared for associated factors. STATISTICAL ANALYSIS USED: Independent t-test, chi-square test, logistic regression analysis, ROC-AUC, Youden index. RESULTS: 606 patients with complete data were analysed for PPM. The incidence of mild, moderate and severe PPM was 6.1% (37), 2.5% (15) and 0.5% (3) respectively. There was no impact of PPM on all-cause in-hospital mortality. PPM was observed more with Aortic Stenosis (AS) compared to Aortic Regurgitation (AR) as etiology. Aortic annulus indexed to BSA (iAA) had a very good predictive ability for PPM at <16mm/m(2) BSA. CONCLUSIONS: PPM has lower incidence after AVR in this Indian population and does not increase early mortality. Patients with AS and iAA<16mm/m2BSA should be cautiously dealt with to prevent PPM.