Type and Size of Implanted Bioprosthetic Valve Rather Than Intraoperative Peak Transprosthetic Valvular Velocity Predict Postoperative Midterm Prosthesis-Patient Mismatch in Patients Undergoing Surgical Aortic Valve Replacement.

ABSTRACT

OBJECTIVES: High transprosthetic valvular peak velocity (PV) is indicative of prosthesis-patient mismatch (PPM), which exacerbates mortality and morbidity after surgical aortic valve replacement (AVR). During surgical AVR, a high intraoperative PV sometimes is detected, but whether it affects mortality and morbidity is unknown. The aims of this study were to determine whether intraoperative and postoperative PV were correlated and what factors predicted postoperative PPM. DESIGN: Retrospective, observational, cohort study. SETTING: Tertiary medical center. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study comprised 556 patients who underwent AVR with a bioprosthetic valve. PV was measured intraoperatively, 1 month after surgery, and 1 year after surgery. The occurrence of PPM was defined as an effective orifice area index of less than 0.85 cm2/m2. The associations between PV values at the aforementioned 3 time points were analyzed using a multivariable nonlinear regression model. A multivariable logistic regression model was used to identify the predictors of PPM at 1 year. There was no significant association between intraoperative PV and PV at 1 month (p = 0.419) or 1 year (p = 0.115). The implanted valve type (p < 0.001) and size (p < 0.001), but not intraoperative PV (p = 0.503), were independent predictors of PPM. CONCLUSIONS: There was no significant association between intraoperative and postoperative PV values. Implanted valve type and size, but not intraoperative PV, predicted postoperative PPM.