Prosthesis-patient mismatch after mitral valve replacement in adults

Objective To observe the incidence of prosthesis-patient mismatch(PPM) after mitral valve replacement(MVR) in adults and its effect on systolic pulmonary artery pressure(SPAP),heart function and pulmonary infection of patients with mitral valvular diseases. Methods One hundred and two patients(36 males,66 females) at the age of 35-71 years(56.5±8.0 years) who underwent MVR from September 2008 to October 2010 in our hospital were included in this study.MVR was performed under general anesthesia and extracorporeal circulation.Tricuspid annuloplasty(TAP),coronary bypass(CB) and left atrium folding were performed for those complicated with triscupid prolapse or insufficiency,coronary artery disease(CAD) and huge left atrium.The patients were followed up for 1 year after operation.When the effective orifice area(EOAi) of mitral valve ≤ 1.2cm²/m² was defined as PPM,the 102 patients were divided into PPM group and non-PPM group.SPAP ≥ 40mmHg was defined as pulmonary artery hypertension(PAH).Data about the patients in two groups were compared before,during and after operation,respectively. Results PPM occurred in 20 patients during the follow-up,with the incidence of 19.61%.The proportion of PPM of male patients,BSA before operation,application of 25mm valve during operation,and BSA,SPAP,EOAi,PAH,NYHA ≥ 3-4,right heart failure and pulmonary infection during the follow up were significantly higher in PPM group than in non-PPM group(P<0.05). Conclusion PPM is not uncommon in adults after MVR.The incidence of PPM can be reduced by avoiding the use of 25mm valve during MVR.