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Impact of Prosthesis-Patient Mismatch After Surgical Mitral Valve Replacement: Systematic Review and Meta-Analysis
Xander Jacquemyn1, Ganduboina Rohit2, Michel Pompeu Sá3
1UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
The American Journal of Cardiology
|April 18, 2026
Summary
Mitral prosthesis-patient mismatch (PPM) is common after mitral valve replacement (MVR), significantly increasing long-term mortality and heart failure hospitalizations. Avoiding PPM is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Mitral prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) has unclear long-term clinical effects.
- Understanding PPM's impact on mortality and heart failure is essential for surgical planning.
Purpose of the Study:
- To systematically assess the prevalence of mitral PPM.
- To evaluate the association between mitral PPM and long-term mortality, cardiac death, and heart failure hospitalizations.
Main Methods:
- Systematic review and meta-analysis of observational studies.
- Analysis of Kaplan-Meier time-to-event data from 16 studies (10,872 patients).
- Assessment of all-cause mortality, cardiac mortality, and heart failure hospitalizations.
Main Results:
- The pooled prevalence of mitral PPM was 43%.
- Mitral PPM was associated with increased all-cause mortality (HR 1.32), cardiac mortality (HR 1.96), and heart failure hospitalizations (HR 2.82).
- A dose-response relationship was observed, with severe PPM showing significantly higher mortality risk (HR 1.36).
Conclusions:
- Mitral PPM is prevalent and an independent predictor of adverse long-term outcomes post-MVR.
- Severity of PPM correlates with increased mortality risk.
- Preventive strategies to avoid PPM during MVR planning are recommended.
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