Impact of aortic valve prosthesis-patient mismatch on left ventricular mass regression

Abstract

Background: Aortic valve replacement (AVR) aim to allow left ventricular mass (LVM) regression by relieving valve stenosis and lowering LV pressure. When the effective orifice area (EOA) of the prosthetic valve that has been placed is too small in comparison to the body surface area, it is known as valve prosthesis-patient mismatch (PPM). Thus, the aim of this investigation is to determine if PPM and the degree of LVM regression following AVR are related. Patients and Methods: The study was a prospective cohort study of 100 patients with isolated aortic stenosis who underwent AVR for 2 years and were placed in two groups (50 patients in each group); group A consisted of patients with no PPM [indexed effective orifice area (IEOA) > 0.85 cm 2 /m 2 ], and group B consisting of patients with PPM (IEOA ≤ 0.85 cm 2 /m 2 ). The main outcomes of interest are type, size, EOA, and IEOA of the prosthetic aortic valve used, follow-up echocardiography after 12 months including gradient across the prosthetic valve, LVM, and LVM regression. Results: Significant differences were observed between the two groups. In the PPM group, there were fewer reductions in both mean and peak aortic valve gradients compared to the no PPM group. LVM showed a marked absolute regression in the no PPM group (87.0 ± 30.6 g) compared to the PPM group (39.1± 15.9 g, P < 0.001). Conclusion: This study shows that PPM may hamper the regression of LVM after AVR.