Prosthesis-patient mismatch after surgical aortic valve replacement in patients with aortic stenosis

OBJECTIVES The issue of prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) has been a controversial topic. We sought to evaluate the long-term clinical impacts of PPM in patients undergoing SAVR in an updated, homogeneous cohort. METHODS Using the prospective institutional database, we identified 895 adult patients (median age 66, interquartile range 58–72; 45.6% women) who underwent isolated SAVR from January 2000 to March 2016. Those with pure aortic insufficiency and concomitant other cardiac operations were excluded from this study cohort. The presence of a significant PPM was defined as an indexed effective orifice area 0.85 cm2/m2 or less. The outcome of interest was all-cause deaths. Propensity score matching was performed for adjusting bias. RESULTS Significant PPM was present in 247 patients (27.6%). During the follow-up period (mean 71.2 ± 51.04 months), 134 patients (15%) died. Survival rates at 10 and 15 years were 78.3% vs 83.8% and 71.3% vs 57.6% in the PPM and non-PPM groups (P = 0.972). Risk factor analysis indicated that developing PPM was not associated with a risk of death. After propensity score matching (1:1), developing PPM was not a risk factor for long-term death as well (P = 0.584). CONCLUSIONS Significant PPM was common after SAVR in patients with aortic stenosis. However, there was no significant difference in survival rate between those with and without PPM.