Prosthesis-Patient Mismatch Negatively Affects Outcomes after Mitral Valve Replacement: Meta- Analysis of 10,239 Patients

Abstract

Objective This study sought to evaluate the impact of prosthesis-patient mismatch on the risk of perioperative and long-term mortality after mitral valve replacement. Methods Databases were researched for studies published until December 2018. Main outcomes of interest were perioperative and 10-year mortality and echocardiographic parameters. Results The research yielded 2,985 studies for inclusion. Of these, 16 articles were analyzed, and their data extracted. The total number of patients included was 10,239, who underwent mitral valve replacement. The incidence of prosthesis-patient mismatch after mitral valve replacement was 53.7% (5,499 with prosthesis-patient mismatch and 4,740 without prosthesis-patient mismatch). Perioperative (OR 1.519; 95%CI 1.194-1.931, P <0.001) and 10-year (OR 1.515; 95%CI 1.280-1.795, P <0.001) mortality was increased in patients with prosthesis-patient mismatch. Patients with prosthesis-patient mismatch after mitral valve replacement had higher systolic pulmonary artery pressure and transprosthethic gradient and lower indexed effective orifice area and left ventricle ejection fraction. Conclusion Prosthesis-patient mismatch increases perioperative and long-term mortality. Prosthesis-patient mismatch is also associated with pulmonary hypertension and depressed left ventricle systolic function. The findings of this study support the implementation of surgical strategies to prevent prosthesis-patient mismatch in order to decrease mortality rates.

Prosthesis–patient mismatch after mitral valve replacement: A pooled meta‐analysis of Kaplan–Meier‐derived individual patient data

“…Sixteen retrospective single‐center studies, 4‐6,10‐22 two retrospective multicenter studies, 7,23 and one prospective study 24 were included in the final review and meta‐analysis. Two studies identified were meta‐analyses 25,26 …”

“…Two studies identified were meta-analyses. 25,26 In one study, 19 a two-tailed analysis was performed and EOA was obtained from referenced values or measured with the continuity equation (CE) method. In another study, 15 (Table 1).…”

“…Two previous meta-analyses have explored the effect of PPM after MVR. 25,26 However, certain methodological limitations of these studies need to be acknowledged as well as limitations regarding the interpretation of the results presented. Our meta-analysis was the first to explore the risk factors related to the development of PPM…”

Outcomes Post-Nick's Aortic Root Enlargement Technique: Single-Center Experience

“…1 PPM is associated with higher perioperative and long-term mortality as a result of substandard hemodynamics, pulmonary hypertension, and poor regression of left ventricular hypertrophy. 1,2 Surgical aortic root enlargement (ARE) during AVR allows for the placement of a larger size aortic valve prosthesis, reducing the risks of PPM and improving patient outcomes. 3 A posterior ARE was first suggested by Nick et al in 1970.…”

“… 1 PPM is associated with higher perioperative and long-term mortality as a result of substandard hemodynamics, pulmonary hypertension, and poor regression of left ventricular hypertrophy. 1 2 …”