Canadian Journal of Cardiology
Clinical Research| Volume 32, ISSUE 12, P1493-1499, December 2016

Impact of Prosthesis-Patient Mismatch on Long-term Functional Capacity After Mechanical Aortic Valve Replacement

Published:March 08, 2016DOI:



      The impact of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) for aortic stenosis on exercise capacity remains controversial. The aim of this study was to analyze the long-term impact of PPM after mechanical AVR on maximal oxygen uptake (VO2max).


      The study included 75 patients who had undergone isolated mechanical AVR for aortic stenosis with normal left ventricular (LV) function between 1994 and 2012. Their functional capacity was evaluated on average 4.6 years after AVR by exercise testing, including measurement of their VO2max, and by determining their New York Heart Association functional class and Short Form-36 score. Two groups were defined by measuring the patients' indexed effective orifice area (iEOA) by transthoracic echocardiography: a PPM group (iEOA < 0.85 cm2/m2) and a no-PPM group (iEOA ≥ 0.85 cm2/m2).


      PPM was present in 37.0% of the patients. The percentage of the predicted VO2max achieved was significantly lower in the PPM group (86.7 ± 19.5% vs 97.5 ± 23.0% in the no-PPM group; P = 0.04). Compared with the no-PPM group, the PPM group contained fewer patients in New York Heart Association functional class I and their mean Short Form-36 physical component summary score was significantly lower. The mean transvalvular gradient was significantly higher in the PPM group than in the no-PPM group (P < 0.001). Systolic and diastolic function and LV mass had normalized in both groups.


      PPM is associated in the long term with moderate but significant impairment of functional capacity, despite optimal LV reverse remodelling and normalization of LV systolic and diastolic function.



      Les répercussions de la disproportion patient-prothèse (DPP) sur la capacité à l’effort après le remplacement valvulaire aortique (RVA) pour une sténose aortique demeurent controversées. L’objectif de cette étude était d’analyser les conséquences à long terme de la DPP après le RVA par prothèse mécanique sur la consommation maximale d’oxygène (VO2 max).


      L’étude comptait 75 patients qui avaient subi le RVA isolé par prothèse mécanique pour une sténose aortique associée à une fonction normale du ventricule gauche (VG) entre 1994 et 2012. Leur capacité fonctionnelle était évaluée sur une période moyenne de 4,6 ans après le RVA par une épreuve à l’effort, dont la mesure de leur VO2 max, et la détermination de leur classification fonctionnelle selon le New York Heart Association et leur score au questionnaire SF-36 (Short Form-36). Deux groupes étaient définis par la mesure par échocardiographie transthoracique de la surface fonctionnelle de l’orifice indexée (SFOi) des patients: un groupe DPP (SFOi < 0,85 cm2/m2) et un groupe non-DPP (iEOA ≥ 0,85 cm2/m2).


      La DPP était présente chez 37,0 % des patients. Le pourcentage de prédiction de l’atteinte de la VO2 max était significativement plus faible dans le groupe DPP (86,7 ± 19,5 % vs 97,5 ± 23,0 % dans le groupe non-DPP; P = 0,04). Comparativement au groupe non-DPP, le groupe DPP qui comprenait moins de patients de la classification fonctionnelle I de la New York Heart Association obtenait un score moyen au sommaire de la composante physique du questionnaire SF-36 significativement plus faible. Le gradient transvalvulaire moyen était significativement plus élevé dans le groupe DPP que dans le groupe non-DPP (P < 0,001). Les fonction systolique et diastolique et la masse VG s’étaient normalisées dans les 2 groupes.


      La DPP est associée à long terme à la détérioration modérée, mais significative, de la capacité fonctionnelle, en dépit du remodelage inverse optimal du VG et de la normalisation des fonctions systolique et diastolique du VG.
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