الفهرس 
HISTORY OF AORTIC VALVE REPLACEMENTOnly 14 pages are availabe for public view
 |  | from | 184 |  |  |
| | | from | 184 | | |
Abstract
The effect of PPM on short-term morbidity & mortality, functional recovery, left ventricular remodelling and left ventricular mass (LVM) regression following AVR is conflicting.
This current study is conducted to determine the effect of patient-prothesis mismatch (PPM) on early outcome in patients with pure aortic stenosis who underwent mechanical aortic valve replacement (AVR) and to examine the relation between PPM and the extent of left ventricular mass regression after AVR.
A prospective non-randomized and non blinded analysis was done for ninety patients undergoing isolated aortic valve replacement (AVR) for aortic stenosis. Forty five of them had no PPM (group I) and forty five had PPM (group II) following AVR.
None of them had reoperative procedures, multiple valve replacement or other concomitant procedures including CABG and other aortic valvular lesion than aortic stenosis were excluded from study.
All patients in this study were evaluated clinically preoperatively and postoperatively. Also hemodynamical assessment with transthoracic echocardiography (TTE) +/- transoesophageal echocardiography (TOE) was done preoperatively and six months postoperatively to assess TPG, LVEF, EAO and LVM.
Both groups were comparable regarding preoperative clinical presentation namely (NYHA and CCS) and preoperative co-morbidities. There were no statistically significant differences between the two groups.
ITU stay in group I (1.38 ± 0.89 day), while in group II (2.27± 2.5 days) with satatistically significant difference between the two groups (P value 0.04). Post operative mechanical assisted ventilation in group I (10.6 ± 8.9 hrs); while in group II (8.9 ± 5.2 hrs). Hospital stay, in group I (9.5 ± 3.3 days), while in group II (12.2 ± 10days) with no statistically significant difference between the two groups.
Early post operative complications including reoperation for bleeding or tamponade, pulmonary complications, neurological deficits, post operative acute renal failure, low cardiac output (LCOP), new postoperative arrhythmias and postoperative wound sepsis were statistically non significantly different.
At follow up 6 months postoperatively, both groups improved in their clinical status as regard the NYHA class and CCS class. Group I (88.9%) NYHA class I, group II (82.2%) NYHA class I. In group I (97.7%) CCS class I while in group II (95.6%) CCS class I. (P value NS)
On the six months postoperative echo-Doppler, peak trans-aortic gradient postoperatively; group I (26.9 ± 10.4mmHg) and group II (35 ± 12.1mmHg) (P value <0.005).While LVMI group I (109 ± 24.2 gr/m²) group II (112.7 ± 26.5 gr/m²) (P value NS). LVEF group I (58.6 ± 11.8%) group II mean (57.8 ± 10.3 %) (P value NS).
Early 30-days hospital mortality was equal in the two groups with one patient from each group. In group I, one patient (2.2%) and in group II one patient (2.2%). (P value NS)
The one-year survival in the whole groups was 96.6%. In group I was 98.8% while in group II was 95.6%. Also there was no statistically significant difference between the two groups.
from this study we concluded that that PPM is tolerable, with none significant effect on the early outcome and short term survival. We think proper selection of valve prosthesis will enable surgeons to implant suitable valve with adequate EAOI and adequate haemodynamic performance individually based. This prosthesis can be any of the new high performance stented valves (biological or mechanical) or stentless prosthesis according to patients’ demographics. Aortic root enlargement procedures can be avoided, unless highly indicated, as its performance might adversely affect the outcome without adding much benefit.