Is It Possible To Predict High Transvalvular Gradients In Aortic Valve Surgery?

Introduction: The aim of this study was to determine the prevalence of patient prosthesis mismatch (PPM), projected or potential in our experience and to assess their ability to predict high transprosthetic gradients after cardiac surgery.Material and method: Retrospective study. We included patients undergoing aortic valve replacement alone or combined with CABG. The effective orifice area (EOA) index projected was calculated for each valve type and number. The potential PPM was defined as EOA less than 0.85 cm(2)/m(2). A mean gradient greater than 24 mmHg was considered PPM after cardiac surgery obtained in echocardiogram performed on follow-up. By bivariate correlation, Pearson correlation coefficient was obtained between the mean gradient and EOA variables. In addition, taking the mean gradient as gold standard for PPM, we calculated the sensitivity and specificity of EOA to predict PPM after cardiac surgery. We used the SPSS 12.0 statistical package.Results: We included 29 patients, 72.4% men, mean age 65.4 +/- 10.9 years, 34.5% were surgery combined with CABG. 41.4% received mechanical prosthesis. 20.7% (6/29) had a mean gradient greater than 24 mmHg. We found no correlation between the projected EOA and transvalvular mean gradients (correlation coefficient 0.27, p = 0.14) The EOA had a sensitivity of 18.7% and specificity of 76.9% to predict transvalvular high mean gradients.Conclusions: PPM was very frequent as projected EOA; however had a bad correlation with the finding of high mean transvalvular gradients after cardiac surgery.