Abstract
BackgroundThe evidence on the impact of patient-prosthesis Mismatch (PPM) on survival thus far has been conflicting. The aim of this study was to 1) study the effect of PPM on survival after isolated aortic and mitral valve replacement and 2) Assess the interaction between left ventricular function and PPM on survival.MethodsThe study cohort was patients who underwent isolated Aortic valve replacement (AVR) and Mitral valve replacement (MVR) over a 10-year period from 2008 to 2018. PPM was defined using the projected indexed effective orifice area (EOAi). The cohort was divided into different groups based on the degree of PPM. The severity of PPM was classified using threshold values of EOAi used in the literature. The Kaplan- Meier method was used to compare survival by degree of PPM. Multivariate Cox proportional hazards models were used to generate adjusted hazard ratios (HR) with 95% confidence intervals. An interactive term for ejection fraction (EF) was added to test whether EF modifies the effect of the PPM grade on survival. In addition, sub-group analysis based on left ventricular function was performed.ResultsIn the AVR cohort, there were a total of 1953 patients. The distribution of patients in the different PPM categories was as follows: no PPM 59.7%; moderate PPM 36.8%; severe PPM 3.5%. There was no significant difference in survival between the different groups. At 10 years, the adjusted HR between patients with severe PPM versus no PPM was 1.1(CI 0.5–2.4, p > 0.05) and the HR between those with moderate PPM versus no PPM was 0.97 (CI 0.74–1.23, p > 0.05). In the MVR cohort, there were a total of 298 patients. The distribution of PPM is as follows: no PPM 59.4%; and with PPM 40.6%. Again, there was no significant difference in survival between the groups. At 5 years, the adjusted HR between patients with PPM versus no PPM was 1.45 (CI 0.67–3.14, p > 0.05). In both groups, there was no significant interaction between left ventricular function (LVF) and degree of PPM on survival.ConclusionsIn our study cohort, the degree of PPM was not an independent predictor of survival after AVR or MVR. There was also no significant interaction between LV function and degree of PPM on survival.
Highlights
The evidence on the impact of patient-prosthesis Mismatch (PPM) on survival far has been conflicting
The evidence far has been conflicting with several studies reporting higher mortality and increased incidence of re-operations associated with patient-prosthetic mismatch (PPM) [2,3,4,5,6,7], whereas others have shown no clinical relevance of PPM [8,9,10,11,12,13].The postulated harmful effects of PPM may be attributed to less left ventricular (LV) mass regression with persistent LV hypertrophy, diastolic dysfunction and subsequent systolic LV dysfunction
The effective orifice area index (EOAi) was Patient characteristics and operative data There were a total of 1953 patients who underwent isolated Aortic valve replacement (AVR) in our cohort
Summary
The evidence on the impact of patient-prosthesis Mismatch (PPM) on survival far has been conflicting. The evidence far has been conflicting with several studies reporting higher mortality and increased incidence of re-operations associated with PPM [2,3,4,5,6,7], whereas others have shown no clinical relevance of PPM [8,9,10,11,12,13].The postulated harmful effects of PPM may be attributed to less left ventricular (LV) mass regression with persistent LV hypertrophy, diastolic dysfunction and subsequent systolic LV dysfunction. The potential effect on survival may be a result of increased left atrial pressure and pulmonary hypertension with subsequent right ventricular (RV) dysfunction
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