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Impact of Prosthesis-Patient Mismatch on Survival after Mitral Valve Replacement: A Meta-analysis

Ho-Young Hwang1, Suk-Ho Sohn1, Myoung-Jin Jang1

  • 1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.

The Thoracic and Cardiovascular Surgeon
|October 10, 2018
PubMed
Abstract

Insights

Prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) is linked to worse long-term survival. This meta-analysis confirms PPM negatively impacts patient outcomes following MVR surgery.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Statistics

Background:

  • Prosthesis-patient mismatch (PPM) negatively impacts outcomes after aortic valve replacement.
  • The effect of PPM on outcomes after mitral valve replacement (MVR) remains controversial.
  • This study evaluates PPM's impact on MVR patient survival.

Purpose of the Study:

  • To assess the association between PPM and early and long-term mortality after MVR.
  • To synthesize evidence from existing studies on PPM and MVR outcomes.

Main Methods:

  • A meta-analysis of eleven nonrandomized studies involving 8,072 patients.
  • Literature search across five databases.
  • Primary outcome: all-cause mortality; Secondary outcome: early mortality.
  • Subgroup analyses based on risk of bias, patient demographics, and prosthesis type.

Main Results:

  • Overall PPM incidence was 58.0%.
  • No significant difference in early mortality between PPM and non-PPM groups (OR: 1.35; 95% CI: 0.98-1.86).
  • All-cause mortality was significantly higher in PPM patients post-MVR (HR: 1.39; 95% CI: 1.09-1.77) with moderate to high heterogeneity.
  • Subgroup analysis by mechanical MVR proportion showed low heterogeneity; no other subgroup analyses revealed significant differences.

Conclusions:

  • PPM is associated with increased all-cause mortality after MVR.
  • The findings suggest PPM negatively affects long-term survival in MVR patients.

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