Is patient–prosthesis mismatch a predictor of survival or a surrogate marker of co-morbidities in cardiac surgery?

Dayan, Víctor; Soca, Gerardo; Stanham, Roberto; Lorenzo, Alvaro; Ferreiro, Alejandro

doi:10.1016/j.ijcard.2015.04.161

Cited by 9 publications

(2 citation statements)

References 22 publications

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“…However, some groups report a higher incidence of perioperative stroke in those with any degree of PPM,14 20 22 with one study showing an incidence of perioperative stroke in those with versus without PPM (3.9% vs 2.4%, P=0.02) 16. A higher incidence of renal failure in patients with PPM has been reported in at least three studies 16 21 23.…”

Section: Clinical Outcomesmentioning

confidence: 96%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

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Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.

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Section: Clinical Outcomesmentioning

confidence: 96%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

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“…After excluding duplicates and noneligible studies, 65 studies 7 , 8 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , ...…”

Section: Resultsunclassified

Impact of Prosthesis‐Patient Mismatch After Surgical Aortic Valve Replacement: Systematic Review and Meta‐Analysis of Reconstructed Time‐to‐Event Data of 122 989 Patients With 592 952 Patient‐Years

Sá,

Jacquemyn,

Van den Eynde

et al. 2024

JAHA

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Background It remains controversial whether prosthesis‐patient mismatch (PPM) impacts long‐term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions. Methods and Results We performed a systematic review with meta‐analysis of reconstructed time‐to‐event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses). Sixty‐five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow‐up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio [HR], 1.16 [95% CI, 1.13–1.18], P <0.001). At 20 years of follow‐up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 [95% CI, 1.06–1.11], P <0.001; severe versus no PPM: HR, 1.29 [95% CI, 1.24–1.35], P <0.001). PPM was associated with higher risk of cardiac death, heart failure–related hospitalizations, and aortic valve reinterventions over time ( P <0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta‐regression analysis revealed that populations with more women tend to have higher HRs for all‐cause death associated with PPM. Conclusions The results of the present study suggest that any degree of PPM is associated with poorer long‐term outcomes following surgical aortic valve replacement and provide support for implementation of preventive strategies to avoid PPM after surgical aortic valve replacement.

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