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Impact of Prosthesis-Patient Mismatch After Mitral Valve Replacement: A Propensity Score Analysis
Hideki Tsubota1, Genichi Sakaguchi1, Ryoko Arakaki1
1Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan.
Abstract:
The effect of patient-prosthesis mismatch (PPM) on late outcomes after mitral valve replacement (MVR) remains unclear. We evaluated the impact of PPM after MVR on the late survival using propensity score matching analysis. From 2007 to 2018, 660 consecutive MVRs were performed. Effective orifice areas were obtained from a literature review of in vivo echocardiographic data, and mitral PPM was defined as an effective orifice area index of ≤1.2 cm2/m2. Propensity score matching yielded a cohort of 126 patients with PPM and 126 patients without PPM. Mitral PPM was found in 37.8% of the patients. In the whole matched patients, there were no differences in late survival (log-rank test, P = 0.629) between 2 groups. Patients aged ≤70 years and those aged >70 years had no differences in late survival (log-rank test, P = 0.073 and 0.572). The Cox proportional hazards model for the overall survival showed that mitral PPM tended to decrease survival in patients aged ≤70 years (P = 0.084, hazard ratio [HR] 2.647, 95% CI: 0.876-7.994). Mitral PPM did not adversely affect long-term survival. There may be a tendency of adverse impact on late survival in patients aged ≤70 years. Implanting a safe size rather than larger size prosthesis in mitral position may be an appropriate option in older patients.
Insights
Patient-prosthesis mismatch (PPM) after mitral valve replacement (MVR) did not impact overall survival. However, a trend suggested reduced survival in younger patients (≤70 years) with PPM.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Disease
- Biomedical Engineering
Background:
- Patient-prosthesis mismatch (PPM) after mitral valve replacement (MVR) is a concern for long-term outcomes.
- The precise impact of PPM on late survival following MVR requires further investigation.
Purpose of the Study:
- To evaluate the effect of PPM on late survival after MVR using propensity score matching.
- To analyze survival differences based on age in patients with and without PPM post-MVR.
Main Methods:
- Retrospective analysis of 660 MVR procedures performed between 2007 and 2018.
- Definition of mitral PPM based on effective orifice area index (≤1.2 cm²/m²).
- Propensity score matching created matched cohorts (126 patients with PPM, 126 without) for survival analysis.
Main Results:
- Mitral PPM was present in 37.8% of patients.
- No significant difference in late survival was observed between patients with and without PPM in the overall matched cohort (P = 0.629).
- Subgroup analysis revealed no survival difference in patients aged >70 years, but a trend towards decreased survival in patients aged ≤70 years with PPM (P = 0.084).
Conclusions:
- Mitral PPM does not appear to adversely affect long-term survival after MVR in the general population.
- A potential negative impact of mitral PPM on survival may exist in younger patients (≤70 years).
- Consideration of prosthesis size in MVR, particularly avoiding oversizing in older patients, might be beneficial.
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