Patient-prosthesis mismatch after aortic valve replacement: Effects on left ventricular structure

This study aimed to investigate the effects of patient-prosthesis mismatch (PPM) on left ventricular structure and functional capacity in patients undergoing isolated surgical aortic valve replacement (sAVR) for severe aortic stenosis.

This retrospective analysis included preoperative and postoperative data of 157 consecutive patients who underwent isolated sAVR between January 2016 and January 2023. Body mass index and indexed effective orifice area were calculated. The severity of PPM was assessed using the valve academic research consortium-3 criteria, and patients were categorized into (1) Insignificant PPM and (2) Significant PPM. Left ventricular geometries were classified based on the left ventricular mass index (LVMi) and relative wall thickness. Functional capacity was evaluated according to the New York Heart Association classification.

The mean age of the 91 patients who met the selection criteria was 64.2±8.9 years, and 44% were female and 56% were male. Sixteen patients (17.6%) were assigned to the significant PPM group. The median change in LVMi was -33 g/m² in the insignificant PPM group and -14.5 g/m² in the significant PPM group (p=0.037). Multivariate logistic regression demonstrated a significant association between LVMi change and significant PPM (odds ratio: 1.021, p=0.043). Although no significant change was observed in left ventricular geometry in either the groups, a significant difference was noted in the functional capacity changes (p=0.01).

Avoiding significant PPM provides better regression in LVMi and greater improvement in functional capacity; however, it is not sufficient for a significant change in left ventricular geometr y.