European Heart Journal Advance Access originally published online on September 27, 2007
European Heart Journal 2007 28(21):2620-2626; doi:10.1093/eurheartj/ehm393
Low-gradient aortic stenosis: impact of prosthesis-patient mismatch on survival
1 Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 51 avenue De Lattre de Tassigny, 94010 Créteil, France
2 Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
3 Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France
4 Department of Cardiac Surgery, University Hospital, Strasbourg, France
5 General Hospital, Lorient, France
6 Clinique Saint-Augustin, Bordeaux, France
7 University Hospital, Reims, France
8 General Hospital, Argenteuil, France
9 University Hospital, Amiens, France
Received 2 May 2007; revised 19 July 2007; accepted 23 August 2007; online publish-ahead-of-print 27 September 2007.
* Corresponding author. Tel: +33 1 49 81 23 30; fax: +33 1 49 81 28 83. E-mail address: jean-luc.monin{at}hmn.aphp.fr
Aims: To assess the prognostic impact of prosthesis-patient mismatch (PPM) in a large consecutive series of patients operated for low-gradient aortic stenosis (AS).
Methods and results: Outcomes after surgery for low-gradient AS were prospectively assessed in 152 consecutive patients from seven institutions. There were 113 men (74%); mean age was 72 years (64–76); valve area, 0.7 cm2 (0.6–0.8); left ventricular (LV) ejection fraction 0.31 (0.25–0.37) and baseline mean transaortic pressure gradient (MPG), 30 mmHg (25–35) Among 139 patients with available prosthetic valve effective orifice area (EOA), PPM (defined by an indexed EOA 
0.85 cm2/m2) was present in 79 patients (57%) and had no significant impact on post-operative mortality. Independent predictors of overall mortality were LV contractile reserve [hazard ratio (HR) 0.52; 95% confidence interval (CI) 0.35–0.78; P = 0.002], associated coronary artery bypass grafting (HR 1.87; 95% CI 1.24–2.82; P =0.003), baseline MPG (per 1 mmHg decrease to 10 mmHg; HR 1.03; 95% CI 1.01–1.06; P = 0.021), previous cancer (HR 2.13; 95% CI 1.05–4.29; P = 0.037), and logistic EuroSCORE (per 1% increase; HR 1.02; 95% CI 1.01–1.04; P = 0.040).
Conclusion: In this large multicentre series of patients with low-gradient AS, we found that PPM (moderate in most cases) had no influence on post-operative mortality. Therefore, the performance of more complex interventions in order to avoid moderate PPM may not be justified in the setting of low-gradient AS, because their higher risk probably outweighs the expected benefit.
Key Words: Valves • Stenosis • Surgery • Prognosis
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