Abstract

Patient prosthesis mismatch is known to alter post-operative remodeling of left ventricle adversely in aortic stenosis patients. An indexed orifice area of 0.85 is considered as conventional cutoff for patient prosthesis mismatch based on hemodynamic principles. Many patients have smaller annulus and annulus enlargement techniques may be required to avoid this benchmark which complicates the surgery. Present study was done with an aim of Evaluation of effect of prosthesis-patient mismatch (PPM) on clinical and echocardiographic outcome in patients undergoing aortic valve prosthesis due to aortic valve disease with predominant aortic stenosis. Material and Methods: Present Prospective, longitudinal and comparative study was done at the Department of Cardio Vascular and Thoracic Surgery, Tertiary care teaching institute of India. Patients undergoing aortic valve replacement due to aortic valve disease with predominant aortic stenosis were included in the study. Present study was done on 30 patients for the duration of 2 years. Candidates undergoing aortic valve replacement were examined preoperatively to determine NYHA functional class, BODY SURFACE AREA (BSA), BODY MASS INDEX (BMI). Preoperative echocardiography with Doppler to assess chamber sizes, peak and systolic pressure gradient across the valve, LV mass indexed to BSA, End systolic volume and End diastolic volume. Patients were evaluated with post operative ECHO Doppler and Dobutamine Stress Echo at 6 month and at 1 year Results: Pre operative and post operative mean gradient at rest as well as with dobutamine, in PPM+ positive groups remain more than PPM- groups (p≤0.05). With dobutamine, in both the groups mean gradient increase. PPM+ and PPM- in both the groups LV mass index regresses significantly. The regression does not differ much between the groups. Conclusion: Based on this analysis it is seen that, though the Post operative residual gradient at rest as well as with dobutamine stress remains more in Patients with PPM but the LV Mass index regression, improvement of cardiac index and QUALITY OF LIFE statistically significant in both groups.

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