Predictors and Outcomes of Prosthesis-Patient Mismatch After Aortic Valve Replacement.

OBJECTIVES: This study sought to evaluate predictors of prosthesis-patient mismatch (PPM) and its association with the risk of perioperative and overall mortality.

BACKGROUND: PPM is associated with increased mid- and long-term mortality after surgical aortic valve replacement. Conflicting results have been reported with regard to its association with perioperative mortality.

METHODS: Databases were searched for studies published between 1965 and 2014. Main outcomes of interest were perioperative mortality and overall mortality.

RESULTS: The search yielded 382 studies for inclusion. Of these, 58 articles were analyzed and their data extracted. The total number of patients included was 40,381 (39,568 surgical aortic valve replacement and 813 transcatheter aortic valve replacement). Perioperative (odds ratio: 1.54; 95% confidence interval: 1.25 to 1.91) and overall (i.e., perioperative and post-operative) mortality (hazard ratio: 1.26; 95% confidence interval: 1.16 to 1.36) was increased in patients with PPM. The impact of PPM on mortality was higher in those studies in which the mean age of the patients was <70 years of age (and/or AVR with associated coronary artery bypass graft was included). Severe PPM was associated with increased risk of both perioperative and overall mortality, whereas moderate PPM was associated with increased risk of perioperative mortality but not of overall mortality. The impact of PPM was less pronounced in patients with larger body mass index (>28 kg/m(2)) compared with those with lower index. Predictors of PPM were older age, female sex, hypertension, diabetes, renal failure, larger body surface area, larger body mass index, and the utilization of a bioprosthesis.

CONCLUSIONS: PPM increases perioperative and overall mortality proportionally to its severity. The identification of predictors for PPM may be useful to identify patients who are at higher risk for PPM. The findings of this study support the implementation of strategies to prevent PPM especially in patients <70 years of age and/or with concomitant coronary artery bypass graft.