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Surgical aortic valve replacement and patient-prosthesis mismatch: a meta-analysis of 108 182 patients

Michel Pompeu Barros de Oliveira Sá1,2,3, Martinha Millianny Barros de Carvalho2,3, Dário Celestino Sobral Filho2,3

  • 1Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco-PROCAPE, Recife, Brazil.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 19, 2019
PubMed
Abstract

Insights

Patient-prosthesis mismatch (PPM) after surgical aortic valve replacement significantly increases mortality rates. Severe PPM poses a higher risk, underscoring the need for strategies to prevent PPM and improve patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Biomedical Engineering
  • Clinical Outcomes Research

Background:

  • Patient-prosthesis mismatch (PPM) occurs when the effective size of an implanted prosthetic valve is insufficient for the patient's body size.
  • Surgical aortic valve replacement (SAVR) is a common procedure, but the long-term impact of PPM on mortality requires further investigation.

Purpose of the Study:

  • To evaluate the association between patient-prosthesis mismatch (PPM) and mortality after surgical aortic valve replacement (SAVR).
  • To assess the impact of PPM severity on perioperative, early-, mid-, and long-term mortality.

Main Methods:

  • A systematic literature search was conducted up to March 2018, identifying 70 relevant studies.
  • Data from 108,182 patients who underwent SAVR were analyzed to determine the incidence of PPM and its correlation with mortality outcomes.
  • Meta-analysis was used to calculate odds ratios (OR) and confidence intervals (CI) for mortality at various time points.

Main Results:

  • The incidence of PPM after SAVR was 53.7%.
  • PPM was significantly associated with increased perioperative mortality (OR 1.491), 1-year mortality (OR 1.465), 5-year mortality (OR 1.358), and 10-year mortality (OR 1.534).
  • Both moderate and severe PPM increased mortality risk, with severe PPM demonstrating a higher risk.

Conclusions:

  • Moderate to severe patient-prosthesis mismatch significantly increases mortality rates after surgical aortic valve replacement, in proportion to the severity of the mismatch.
  • These findings advocate for the adoption of surgical strategies aimed at preventing PPM to reduce patient mortality.
Keywords:
Aortic stenosisAortic valve replacementHeart valve prosthesisMeta-analysisProsthesis–patient mismatch

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