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

• Published in: JACC. Cardiovascular imaging 2016-08, Vol.9 (8), p.924-933
• Main Authors: Dayan, Victor, MD, PhD, Vignolo, Gustavo, MD, Soca, Gerardo, MD, Paganini, Juan Jose, MD, Brusich, Daniel, MD, Pibarot, Philippe, DVM, PhD
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; aortic valve replacement; Cardiovascular; Coronary Artery Bypass - adverse effects; Female; Heart Valve Diseases - diagnostic imaging; Heart Valve Diseases - mortality; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Humans; Male; meta-analysis; Odds Ratio; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - mortality; Prosthesis Design; prosthesis-patient mismatch; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2015.10.026

Abstract 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 28 kg/m2 ) 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