Mitral Annular Constraint Shapes Aortic Prosthesis Size and Early Hemodynamics in Combined Aortic and Mitral Valve Surgery

In this single-center study of 651 patients undergoing combined aortic and mitral valve surgery, mitral annular constraint from anterior annular anchoring sutures for mitral replacement or complete-ring annuloplasty was associated with the implantation of smaller aortic prostheses (median, 23 vs 25 mm), higher rates of moderate or severe prosthesis-patient mismatch (33.3 percent vs 21.9 percent), a smaller indexed effective orifice area, less favorable transvalvular gradient reduction, greater morbidity, and lower survival, though the latter differences may partly reflect underlying pathology and operative complexity.