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eComment: Independent risk factors of in-hospital mortality in patients undergoing aortic valve replacement

Bakoulev Center for Cardiovascular Surgery, 121552 Moscow, Russia

Is patient-prosthesis mismatch an independent risk factor for early and mid-term overall mortality in adult patients undergoing aortic valve replacement?

The authors are to be congratulated for this work [1]. Until recently the effect of prosthesis-patient size on survival was controversial.

We studied 403 patients undergoing aortic valve replacement with mechanical heart valve prosthesis. Our experience showed that severe prosthesis-patient mismatch was important for early and late postoperative outcome after aortic valve replacement, particularly in patients with aortic stenosis, high left ventricular mass index, small left ventricular cavity, small left ventricular outflow tract diameter and history of arterial hypertension. But it was not an independent risk factor of in-hospital mortality.

In our series, thirteen (3.23%) patients underwent Manouguian’s aortic root enlargement. Aortic root enlargement itself did not increase operative risk, although it was most often required among high-risk patients. We agree with Dhareshwar et al. [2]that surgeons should not be reluctant to enlarge the aortic root to permit implantation of adequately sized valve prostheses and avoid severe prosthesis-patient mismatch. However, highrisk patients need an individual approach.

Low output syndrome was identified as the common mode of death in our patients with excessive hypertrophy. Diastolic heart failure due to left ventricular chamber or myocardial muscle stiffness in patients with increased left ventricular mass index was an important predictor of 30-day mortality; however, as in Nozohoor’s experience [3], the recovery of diastolic function was not significantly influenced by prosthesis-patient mismatch.

We found that severe heart failure and further poly-organic failure were independent risk factors of in-hospital mortality.

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1. Urso S, Sadaba R, Aldamiz-Echevarria G. Is patient-prosthesis mismatch an independent risk factor for early and mid-term mortality in adult patients undergoing aortic valve replacement? Interact CardioVasc Thorac Surg 2009;9:510–519.[Abstract/Free Full Text]
2. Dhareshwar J, Sundt TM III, Dearani JA, Schaff HV, Cook DJ, Orszulak TA. Aortic root enlargement: what are the operative risks? J Thorac Cardiovasc Surg 2007;134:916–924.[Abstract/Free Full Text]
3. Nozohoor S, Nilsson J, Lührs C, Roijer A, Sjögren J. Influence of prosthesis-patient mismatch on diastolic heart failure after aortic valve replacement. Ann Thorac Surg 2008;85:1310–1317.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Permission Requests Google Scholar Articles by Bockeria, L. A. Articles by Murysova, D. V. PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Murysova, D. V. Related Collections Related Article