Abstract
ObjectiveThis study sought to evaluate the impact of prosthesis-patient mismatch on the risk of perioperative and long-term mortality after mitral valve replacement.MethodsDatabases were researched for studies published until December 2018. Main outcomes of interest were perioperative and 10-year mortality and echocardiographic parameters.ResultsThe 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.ConclusionProsthesis-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.
Highlights
RationaleRecent meta-analyses including several studies with thousands of patients have been published in order to evaluate whether prosthesis-patient mismatch (PPM) is a risk factor for short- and long-term mortality after aortic valve replacement, showing an increase in all-cause mortality[1,2].Since we do not see the same amount of publications when it comes to PPM after mitral valve replacement (MVR), we decided to carry out a new systematic review with meta-analysis in order to evaluate the impact of PPM after MVR
Prosthesis-patient mismatch is associated with pulmonary hypertension and depressed left ventricle systolic function
Considering that we observed an incidence of PPM after MVR higher than 50% that implies higher rates of mortality, it would be no exaggeration to say that this problem has reached epidemic proportions and surgeons would have to take measures to counter the risk of PPM after MVR in order to decrease mortality
Summary
RationaleRecent meta-analyses including several studies with thousands of patients have been published in order to evaluate whether prosthesis-patient mismatch (PPM) is a risk factor for short- and long-term mortality after aortic valve replacement, showing an increase in all-cause mortality[1,2].Since we do not see the same amount of publications when it comes to PPM after mitral valve replacement (MVR), we decided to carry out a new systematic review with meta-analysis in order to evaluate the impact of PPM after MVR.
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