Predicted vs. Observed Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement

Area of Science:

• Cardiology
• Biomedical Engineering
• Surgical Innovation

Background:

• Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is linked to adverse clinical outcomes and reduced valve durability.
• Accurate assessment of PPM is crucial for optimizing patient prognosis post-SAVR.

Purpose of the Study:

• To retrospectively evaluate the consistency between predicted PPM (PPMp) and measured PPM (PPMm) in patients undergoing SAVR.
• To compare PPMp and PPMm across three distinct bioprosthesis types: Magna Ease, Intuity, and Inspiris Resilia.

Main Methods:

• Analysis of 1323 SAVR patients, with complete hemodynamic data available for 872.
• PPMm determined by echocardiogram-measured effective orifice area index (EOAi); PPMp assessed using reference values based on patient and prosthesis characteristics.
• Evaluation of sensitivity, specificity, predictive values, and accuracy of PPMp compared to PPMm, stratified by prosthesis type, size, and diameter.

Main Results:

• Overall consistency between PPMp and PPMm was 72.8% (635/872 patients).
• No significant differences in PPMp-PPMm consistency were observed among the Magna Ease, Intuity, and Inspiris Resilia bioprostheses.
• Discordance between predicted and measured PPM was more pronounced in smaller valve sizes, with overall accuracy of PPMp at 73%.

Conclusions:

• The consistency between predicted and measured prosthesis-patient mismatch after SAVR is suboptimal.
• The predictive accuracy of PPMp is limited, particularly for smaller valve sizes, necessitating careful clinical consideration.
• Current methods for predicting PPM may require refinement to improve accuracy and avoid unexpected measured mismatch, especially in specific patient and prosthesis configurations.