Background and Aim of the Study: Negative impact of prosthesis-patient mismatch (PPM) on long term survival after valve replacement has been reported. However, the effect of PPM after bioprosthetic mitral valve replacement (MVR) has not yet been well examined. The purpose of this study was to investigate the effect of PPM on late outcomes after bioprosthetic MVR for mitral regurgitation (MR). Methods: A total of 181 patients underwent bioprosthetic MVR between April 2008 and December 2016. After excluding patients with mitral stenosis and those with incomplete data, 128 patients were included in the study. Postoperative transthoracic echocardiography was performed for all patients and the effective orifice area (EOA) was calculated using the pressure half-time method. The effective orifice area index (EOAI) was calculated by the formula: EOA/body surface area (BSA). PPM was defined as a postoperative EOAI ≤ 1.2 cm2/m2. The characteristics and outcomes were compared between the groups. Results: There were 34 patients (26.6%) with PPM and 94 patients (73.4%) without PPM. Although proportion of males and BSA were higher in the PPM group, valve size distributions were similar between the two groups. There were no significant differences in the in-hospital mortality and morbidities. Multivariable analysis showed that PPM was an independent predictor of late mortality (hazard ratio [HR] 3.38; 95% confidence interval [CI] 1.69-6.75; p = .001) and death from heart failure (HR 31.03, 95% CI 4.49-214.40, p < .001). Conclusions: PPM after MVR for MR was associated with long-term mortality and death from heart failure.

We report herein successful treatment of a case of acute type A aortic dissection complicated by cardiac tamponade and mesenteric malperfusion. The patient was a 60-year-old man, with back and abdominal pain and in shock, who was transported to our hospital 2 hours after symptom onset. Computed tomography revealed DeBakey type I dissection with massive hemopericardium and obstruction of both the celiac artery and superior mesenteric artery. After emergency pericardiotomy and removal of the hematoma, superior mesenteric artery-external iliac artery bypass was constructed with a vein graft, and this restored mesenteric perfusion. Open distal hemiarch replacement was then performed. The postoperative course was uneventful. Superior mesenteric artery revascularization achieved immediately after release of the cardiac tamponade prevented further mesenteric ischemia and paved the way for the aortic repair.