Abstract 17651: Long-Term Outcomes of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Individual Patient Data

Abstract

Introduction - It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement (SAVR). Hypothesis - PPM is associated with poor outcomes after SAVR. Methods - Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by March 2023. Results - 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 (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, respectively (moderate vs no PPM: HR 1.09; 95%CI 1.06-1.11; p<0.001; severe vs no PPM: HR 1.29; 95%CI 1.24-1.35; p<0.001). RMST was 0.8 years shorter in patients with moderate PPM, and 2.1 years shorter in patients with severe PPM in comparison with patients without PPM (10.2 years and 8.9 years vs. 11.0 years respectively, p<0.001). PPM was associated with higher risk of cardiac death, HF-related hospitalizations and aortic valves reinterventions over time (p<0.001). Statistically significant associations between PPM and worse survival were observed regardless of type of valves (bioprosthetic vs mechanical valves), contemporary PPM definitions unadjusted and adjusted to 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 SAVR and provide support for implementation of preventive strategies to avoid PPM after SAVR.