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Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve Replacement

Victor Dayan1, Gustavo Vignolo1, Gerardo Soca1

  • 1Centro Cardiovascular, Hospital de Clinicas, Universidad de la Republica, Montevideo, Uruguay.

JACC. Cardiovascular Imaging
|May 30, 2016
PubMed
Abstract

Insights

Prosthesis-patient mismatch (PPM) increases perioperative and overall mortality after aortic valve replacement, especially in younger patients. Identifying PPM predictors like older age and female sex can help manage high-risk individuals.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Biomedical Engineering

Background:

  • Prosthesis-patient mismatch (PPM) is linked to increased mortality after surgical aortic valve replacement (SAVR).
  • Previous research shows conflicting results regarding PPM's impact on perioperative mortality.

Purpose of the Study:

  • To identify predictors of prosthesis-patient mismatch (PPM).
  • To assess the association between PPM and perioperative and overall mortality risk.

Main Methods:

  • A systematic review and meta-analysis of studies published between 1965 and 2014.
  • Inclusion of 58 articles analyzing data from 40,381 patients (SAVR and transcatheter aortic valve replacement).
  • Extraction of data on perioperative and overall mortality outcomes.

Main Results:

  • PPM was associated with increased perioperative (OR: 1.54) and overall mortality (HR: 1.26).
  • The impact of PPM on mortality was greater in patients <70 years and those undergoing AVR with coronary artery bypass graft.
  • Severe PPM increased both perioperative and overall mortality; moderate PPM increased perioperative mortality only.

Conclusions:

  • PPM significantly increases perioperative and overall mortality, with risk proportional to severity.
  • Identifying PPM predictors (e.g., older age, female sex, larger body size) aids in risk stratification.
  • Strategies to prevent PPM are recommended, particularly for patients <70 years or with concomitant coronary artery bypass graft.
Keywords:
aortic stenosisaortic valve replacementheart valve prosthesismeta-analysisprosthesis-patient mismatch

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