No Mismatch

Ms. Brianda Ripoll¹, Mr  Ahmed Omran¹, Mr Walid Elmahdy¹

¹Leeds Teaching Hospitals, Leeds, United Kingdom

Objective:

PPM is a relevant factor before intervention on the aortic valve, but the current tools to prevent it are controversial.

This single-centre study presents a modern clinical framework for patient selection and anticipation of PPM guiding surgeon´s surgical strategy to avoid PPM.

Authors present the results of the first 100 patients after its implementation with 0 Mismatch.

Methods:

Physicians followed a combined decision-making flowchart with tailored patient metrics for surgical planning to prevent PPM between 2020 and 2024. 60% of patients were further discussed in a No Mismatch multidisciplinary meeting prior to surgery.

Results presented on SPSS v30 level of agreement, level of correlation  and level of independence between  valve predicted (VP), valve required (VR) and valve implanted (VI).

Results:

The following total Intraclass Correlation Coefficient was found: In patients < 60 years old 0,92 (Excellent agreement), 60 – 70 years old 0,64 (Moderate agreement), < 70 years old 0,76 (Good agreement).  The hinge point for surgical prevention of PPM found was VP/VR = 0.90.

Conclusion:

PPM can be prevented through focused patient investigation and surgical assessment of the aortic valve.

With a simple formula predicting mismatch, patients with predicted mismatch had either root enlargement, or sutureless valve, or simple did not have mismatch and had a good valve size implanted, yet the surgeon was ready with options.

The results of our initial 100 cases emphasize the current need for developing personalised medicine in aortic valve surgery. Patient selection and No-Mismatch MDT approach are key to develop a tailored strategy before aortic valve replacement and can significantly avoid PPM.