Impact of patient-prosthesis mismatch on exercise capacity in patients after bioprosthetic aortic valve replacement

Objective: It is presumed that patient-prosthesis mismatch (PPM) influences morbidity and mortality after aortic valve replacement (AVR). The aim of our study was to determine the impact of PPM on physical capacity. Methods: Six months after AVR with a bioprosthesis, stress echocardiography was performed on a bicycle ergometer in 312 patients. Depending on gender, age and weight, the target exercise level for every patient was determined by a reference table. Maximum achieved workload is given as percentage of the predicted exercise capacity (PPEC). PPM was defined as an effective orifice area index <= 0.85 cm(2)/m(2). Results: PPM was present in 34.3% of the patients. In patients with or without PPM, age (72.5 (6.9) vs 72.7 (6.7) years, p = 0.806), preoperative ejection fraction (p=0.557) and body surface area (1.85 (0.21) m(2) vs 1.84 (0.18) m(2), p= 0.715) were not significantly different. Male gender was more frequent in patients without PPM (65.4% vs 45.8%, p= 0.001). Patients without PPM achieved 65% (25%) PPEC on the ergometer vs 57% (24%) in patients with PPM (p=0.003). Stepwise linear regression analysis revealed the presence of PPM (p=0.007) and concomitant coronary revascularisation (p=0.010) as significant influencing factors on PPEC. Conclusion: The present study reveals a significant impact of PPM on physical capacity, measured by exercise testing, in patients after AVR. Although other factors such as training status and comorbidity ( for example, concomitant coronary revascularisation) also influence the achievement of higher exercise levels, our data strengthen the hypothesis that the avoidance of PPM could result in better exercise capacity for patients after AVR.