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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Published on: May 21, 2017

Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement

Bart M Koene, Mohamed A Soliman Hamad, Wobbe Bouma

    Journal of Cardiothoracic Surgery
    |April 19, 2013
    PubMed
    Abstract

    Insights

    Prosthesis-patient mismatch (PPM) does not independently predict mortality after aortic valve replacement (AVR) or AVR with coronary artery bypass grafting (CABG). This study found no significant impact of PPM on early or late survival rates in these cardiac surgery patients.

    Area of Science:

    • Cardiovascular Surgery
    • Medical Devices
    • Clinical Outcomes

    Background:

    • Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) has a debated impact on patient survival.
    • This study investigated PPM's effect on early (≤30 days) and late (>30 days) mortality following AVR, with or without concomitant coronary artery bypass grafting (CABG).

    Purpose of the Study:

    • To clarify the controversial role of PPM in AVR outcomes.
    • To assess PPM's influence on both short-term and long-term mortality after AVR and AVR with CABG.

    Main Methods:

    • A retrospective analysis of 2976 patients undergoing AVR or AVR with CABG between 1998 and 2012.
    • PPM defined as indexed effective orifice area (EOAI) ≤0.85 cm²/m²; survival analyzed using Kaplan-Meier and Cox regression.
    • Logistic regression identified predictors of early mortality; Cox regression identified predictors of late mortality.

    Main Results:

    • Early mortality was 6.7% in the PPM group versus 4.7% in the no-PPM group (p=0.013).
    • Late mortality at 1, 5, and 10 years was comparable between groups (e.g., 10-year mortality: 43% PPM vs. 33% no PPM).
    • PPM was not identified as an independent predictor for either early or late mortality.

    Conclusions:

    • Prosthesis-patient mismatch is not an independent predictor of early or late mortality after AVR or AVR with CABG.
    • Other factors like age, LV function, and comorbidities are significant predictors of mortality.

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