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The effect of patient-prosthesis mismatch on survival after aortic and mitral valve replacement: a 10 year, single

Sudeep Das De1, Ashok Nanjappa2, Karim Morcos2

  • 1Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK. sdasde@gmail.com.

Journal of Cardiothoracic Surgery
|December 8, 2019
PubMed
Abstract

Insights

Patient-prosthesis mismatch (PPM) did not significantly impact survival after aortic or mitral valve replacement. Left ventricular function also did not interact with PPM to affect patient outcomes in this study.

Area of Science:

  • Cardiovascular Surgery
  • Prosthetic Heart Valves
  • Clinical Outcomes Research

Background:

  • Conflicting evidence exists regarding the impact of patient-prosthesis mismatch (PPM) on survival after valve replacement.
  • This study aimed to clarify the relationship between PPM and survival following isolated aortic and mitral valve replacement.

Purpose of the Study:

  • To investigate the effect of PPM on survival after isolated aortic valve replacement (AVR) and mitral valve replacement (MVR).
  • To assess the interaction between left ventricular function and PPM in predicting survival outcomes.

Main Methods:

  • A cohort of 1953 AVR and 298 MVR patients from 2008-2018 were analyzed.
  • Patient-prosthesis mismatch (PPM) was defined by indexed effective orifice area (EOAi), with survival analyzed using Kaplan-Meier and Cox proportional hazards models.
  • Interaction between ejection fraction (EF) and PPM on survival was tested, with subgroup analysis based on left ventricular function.

Main Results:

  • In the AVR cohort, no significant difference in survival was observed across PPM severity groups (severe PPM vs. no PPM: adjusted HR 1.1; moderate PPM vs. no PPM: adjusted HR 0.97).
  • In the MVR cohort, no significant survival difference was found between patients with and without PPM (PPM vs. no PPM: adjusted HR 1.45 at 5 years).
  • No significant interaction was detected between left ventricular function and the degree of PPM on survival in either cohort.

Conclusions:

  • The degree of patient-prosthesis mismatch (PPM) is not an independent predictor of survival after isolated aortic or mitral valve replacement.
  • Left ventricular function does not significantly interact with PPM to influence survival outcomes in patients undergoing AVR or MVR.
Keywords:
Aortic valveMitral valveSurvival

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