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Moderate patient-prosthesis mismatch predicts cardiac events and advanced functional class in young and middle-aged

Daniel Hernandez-Vaquero1, Jose M Garcia, Rocio Diaz

  • 1Department of Cardiac Surgery, Central Universitary Hospital of Asturias, Oviedo, Spain.

Journal of Cardiac Surgery
|December 17, 2013
PubMed
Abstract

Insights

Patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) in younger patients significantly increases cardiac events and worsens functional class. However, PPM does not appear to impact overall mortality in this group.

Area of Science:

  • Cardiovascular Surgery
  • Prosthetic Valve Performance
  • Clinical Outcomes Research

Background:

  • Patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) is a concern, but its impact on younger and middle-aged patients is not well understood.
  • This study investigates the mid-term clinical significance of PPM in patients under 70 undergoing isolated AVR.

Purpose of the Study:

  • To evaluate the mid-term impact of PPM on overall mortality, quality of life, and cardiac events in patients younger than 70 undergoing AVR.
  • To determine if PPM is an independent predictor of adverse outcomes in this specific demographic.

Main Methods:

  • Analysis of 293 patients younger than 70 who underwent isolated AVR between 2005 and 2011.
  • PPM defined as indexed effective orifice area ≤ 0.85 cm(2)/m(2).
  • Propensity score-stratified analysis to assess the impact of PPM on mortality, cardiac events, and New York Heart Association functional class.

Main Results:

  • 81 patients (27.61%) experienced some degree of PPM.
  • PPM did not significantly affect mid-term overall mortality (HR=1.45; p=0.36).
  • PPM was associated with a significant increase in cardiac events (HR=11.52; p<0.001) and a worse functional class (RR=7.55; p<0.001).

Conclusions:

  • Moderate PPM is a strong, independent predictor of cardiac events and advanced functional class in younger and middle-aged AVR patients with severe aortic stenosis.
  • PPM may not influence overall mortality in this patient population.
  • These findings highlight the importance of considering PPM in AVR selection for younger patients.

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