Bharathguru N.1, Divya Mallikarjun2, Shreedhar S. Joshi3, Shilpa Suresh4, Giridhar Kamalapurkar5
BACKGROUND
Valve replacement has become the mainstay of management for rheumatic heart
diseases. However, an important and frequent complication of valve replacement
is patient prosthesis mismatch (PPM). The present study was undertaken to
evaluate a single institution experience on the clinical pattern and presentation of
PPM, and the outcomes of double valve replacement surgery.
METHODS
This retrospective, regional study was carried out among 316 consecutive patients
who underwent concomitant aortic and mitral valve surgery (with or without
tricuspid annuloplasty) in this tertiary care hospital. Particulars regarding the
clinical profile and procedure details (valve types and sizes and priority of surgery)
of these patients were documented from the medical records.
RESULTS
In this institute, the valves used were predominantly mechanical (92.6 %) when
compared to bioprosthesis in 7.4 % (47/632 valves - 23 mitral position and 24 in
aortic position). The most common sizes used in the aortic and mitral position
were 21 mm & 27 mm respectively. In spite of the seemingly lower sizes used in
the patients undergoing double valve replacement (DVR) the incidence of PPM is
less owing to the fact that the population under study had a lower body surface
area (BSA) and body mass index (BMI) - 1.17 ± 0.3 & 19.86 ± 3.9 respectively.
CONCLUSIONS
It may be emphasized that if the valve size required to be implanted is derived
based on the patient’s BSA and indexed effective orifice area, the incidence of
patient prosthesis mismatch can be minimized drastically and with it the in-hospital
mortality and morbidity.
