Mismatch paciente-prótesis aórtica. Comparación alejada por eco-Doppler transtorácico versus el estimado en el preoperatorio

BackgroundPatient-aortic valve prosthesis mismatch (PPM) is associated with poor postoperative outcomes. Determination of aortic effective orifice area (EOA) indexed for body surface area (BSA) is useful to select suitable type and size of heart valve prosthesis in order to prevent patient-prosthesis mismatch. ObjectiveThe objective of this study was to compare the PPM estimated by indexed EOA with PPM determined by echo-Doppler at late follow up. Material and MethodsFifty seven patients (43 men) who had undergone an aortic valve replacement in the previous 6 months were retrospectively assessed. After calculating BSA from the surgical report, indexed EOA, postoperative EOA (determined by the continuity equation with transthoracic echo-Doppler), preoperative and postoperative PPM were compared. An indexed EOA < 0.75 cm2 /m2 was considered aortic PPM. ResultsThe prevalence of preoperative and postoperative PPM was 29.8% and 54.4%, respectively (p=0.029); 31% of MMP was severe. The prevalence of overweight in this sample was 80%. ConclusionsIn this group of patients with a high prevalence of overweight and patient-aortic valve prosthesis mismatch, the use of preoperative reference values of EOA indexed for BSA, and the EOA measured by echo-Doppler at late follow-up, showed significant differences between preoperative PPM and postoperative PPM. Further studies should not only include a larger sample, but should also check the method used for calculating valvular area (for example, in the left ventricular outflow tract).