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Thorac Cardiovasc Surg 2024; 72(03): 197-204
DOI: 10.1055/s-0043-1768033
Original Cardiovascular

Prosthesis–Patient Mismatch after Aortic Valve Replacement with the Mosaic Ultra Bioprosthesis

Vasileios Ntinopoulos 
1   Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
,
Hector Rodriguez Cetina Biefer
1   Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
,
Stak Dushaj
1   Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
,
Laura Rings
1   Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
,
Philine Fleckenstein
1   Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
,
Omer Dzemali  ‡   *
1   Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
,
Achim Haeussler‡   *
1   Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
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Abstract

Background Several studies have reported high rates of prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR) with the Mosaic prosthesis. This work assesses the incidence of PPM after AVR with a modified version of the Mosaic prosthesis, the Mosaic Ultra.

Methods We performed a retrospective analysis of the data of 532 patients who underwent AVR with implantation of the Mosaic Ultra prosthesis in the period 2007–2016 in our institution. Patients were classified according to their indexed effective orifice area (EOAi) to severe (EOAi < 0.65 cm2/m2), moderate (EOAi 0.65–0.85 cm2/m2), and absent/mild PPM (EOAi > 0.85 cm2/m2). In-hospital postoperative outcomes and the impact of PPM on mean transvalvular pressure gradient after stratification by prosthesis size were assessed.

Results Overall, 3 (0.6%) patients had severe, 92 (17.3%) moderate, and 437 (82.1%) absent/mild PPM. There was a significant difference in PPM proportions (moderate/severe vs absent/mild PPM) across different prosthesis sizes overall (p < 0.0001), observing gradually increasing rates of PPM with decreasing prosthesis sizes. Patients with moderate/severe PPM had higher mean transvalvular pressure gradients (19 [13–25] vs 13 [10–17] mm Hg, p < 0.0001) than patients with absent/mild PPM. There was a significant difference in mean transvalvular pressure gradient between the different aortic valve prosthesis sizes overall (p < 0.0001), observing gradually increasing gradients with decreasing prosthesis sizes.

Conclusion Patients undergoing AVR with the smaller sized (19, 21, and 23 mm) Mosaic Ultra aortic valve prostheses exhibit a higher risk for moderate/severe PPM and higher mean aortic transvalvular pressure gradients than patients receiving the larger sized (25, 27, and 29 mm) prostheses.

Keywords

aortic valve and root - heart valve surgery - outcomes

Authors' Contribution

O.D. and A.H. contributed equally in conceptualization, investigation, methodology, project administration, resources, supervision, writing – original draft, writing – review and editing of the work.


* These authors contributed equally to this work.




Publication History

Received: 20 November 2022

Accepted: 27 February 2023

Article published online:
09 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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