Key result
Patient-prosthesis mismatch after AVR is linked to ~59% less long-term NYHA class reduction.
Why the study?
The influence of patient-prosthesis mismatch on outcomes after aortic valve surgery remains a topic of discussion, particularly when using a No 19 prosthesis.
Does severe patient-prosthesis mismatch affect early and late mortality and clinical improvement in patients undergoing aortic valve replacement with a No. 19 prosthesis?
Cohort (n=175)
No
Does severe patient-prosthesis mismatch affect early and late mortality and clinical improvement in patients undergoing aortic valve replacement with a No. 19 prosthesis?
Absolute Event Rate: 26.6% vs 64.7%
p-value: p=<0.0001
In patients undergoing aortic valve replacement with a small (No. 19) prosthesis, severe patient-prosthesis mismatch does not significantly increase mortality but significantly limits long-term symptomatic improvement.
May limit symptomatic benefit after small AVR; leaves open optimal prosthesis strategies pending prospective trials.
INTRODUCTION: Patient-prosthesis mismatch (PPM) continues to be a crucial topic of discussion regarding its influence on the aortic valve surgery results. The aim of our study is to evaluate the incidence of mismatch and its influence on early and late results in aortic valve replacement using prosthesis No 19. METHODS: A cohort of 175 patients underwent aortic valve replacement with prosthesis No-19 and was followed for up to 10 years. PPM was defined according to indexed effective orifice valve area (EOAi). Early results were evaluated through hospital mortality, and the data were collected from hospital recordings. Long-term follow-up was realized by contacting the patients by phone. The endpoints were mortality and the clinical status assessed by New York Heart Association (NYHA) class change after intervention. RESULTS: The overall and severe mismatch incidence was 69.1% and 29.7%, respectively. Overall, hospital mortality is 3.4%. Severe mismatch (p=0.057) and continuous values of indexed effective orifice area (p = 0.079), adjusted for sex and age, do not affect early mortality. Severe mismatch and indexed effective orifice area were associated with less post-operative improvement of NYHA functional class (p<0.015) in the long term, independently from other predictors. CONCLUSIONS: Severe mismatch and small indexed orifice areas do not affect early and late mortality, but they are related, importantly, with less symptomatic improvement in the long-term outcomes.
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Dumani et al. (2025) conducted a cohort in Aortic valve disease requiring replacement (n=175). Patient-prosthesis mismatch (PPM) vs. No patient-prosthesis mismatch was evaluated on NYHA class reduction (p=<0.0001). Patient-prosthesis mismatch after aortic valve replacement with a No. 19 prosthesis significantly reduced long-term symptomatic improvement, with only 26.6% of mismatched patients experiencing NYHA class reduction compared to 64.7% of those without mismatch.
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