Abstract

CORTELLEZZI, ZULY et al. Desproporción prótesis-paciente en la cirugía de sustitución valvular aórtica y mortalidad quirúrgica. Rev.Urug.Cardiol. [online]. 2009, vol.24, n.1, pp.5-12. ISSN 0797-0048.

The incidence of prosthesis-patient mismatch (PPM) expressed as the indexed effective orifice area (IEOA) varies between 19%-70% and its effect on morbidity and mortality is controversial. This is of interest because the frequency of the procedure. Objective: determine cumulative incidence of PPM and surgical mortality in patients selected for aortic valve replacement surgery (AVRS). Material and method: between January 2004 and June 2007, 131 surgeries for aortic stenosis were done. PPM incident case if AOEI <0,85 cm²/m²; moderate between 0,85-0,65 and severe <0,65. In 13 (9,9%) was not possible to determine EOA. Surgical mortality is considered as the Society of Thoracic Surgeons, USA. The cumulative incidence (95% CI) were calculated stratified by severity of the PPM. The association PPM - surgical mortality was explored by exact test. Results: The cumulative incidence of PPM was 41/118 (34,7%, 95% CI: 26%-44%), moderate in 26/118 patients (22,0%, 95% CI: 15%-31%) and severe in 15/118 (12,7 %, 95% CI: 7%-20%). In all the surgical mortality was 10/131 (7,6%, 95% CI: 4%-14%), and the PPM was estimated to be 9 / 118 (7,6%, 95% CI: 4%-14%). In patients without PPM was 6 / 77 (7,8%, 95% CI: 3%-17%) similar to the PPM which was 3 / 41 (7,3%, 95% CI: 2%-20%), p=1. In the PPM moderate surgical mortality was 1/26 (3,8%, 95% CI: 1%-19%) and severe PPM 2/15 (13%, 95% CI: 2%-40%). Conclusion: more than 30% of patients with AVRS had PPM, being severe in 13%. No association was found between PPM and surgical mortality.

Keywords : AORTIC VALVE REPLACEMENT SURGERY; PROSTHESIS-PATIENT MISMATCH; INCIDENCE; SURGICAL MORTALITY.

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