Key result
Moderate to severe patient prosthesis mismatch predicted worse long-term survival after isolated aortic valve replacement (HR 3.56; 95% CI 1.37-9.25; p=0.009).
Why the study?
The impact of manufacturer-labeled prosthesis size and predicted effective orifice area on long-term survival after aortic valve replacement was not clear.
Does moderate to severe predicted patient prosthesis mismatch or smaller valve size reduce long-term survival in patients undergoing isolated aortic valve replacement?
Cohort (n=3,444)
Does moderate to severe predicted patient prosthesis mismatch or smaller valve size reduce long-term survival in patients undergoing isolated aortic valve replacement?
Hazard Ratio: 3.56 (95% CI 1.37–9.25)
p-value: p=0.009
Moderate to severe predicted patient prosthesis mismatch and smaller valve sizes are associated with significantly reduced long-term survival after isolated aortic valve replacement.
Introduction The impact of manufacturer labeled prosthesis size and predicted effective orifice area (EOA) on long-term survival after aortic valve replacement is not clear although indexed effective orifice area (iEOA) has been associated with worse survival. Methods Data was retrospectively collected from Jan 2000–Dec 2019 for prosthesis type, model, and size for isolated aortic valve replacements. Stratified survival was compared between groups and subgroups for labeled valve size, EOA and predicted patient prosthesis mismatch (PPM). Results A total of 3444 patients were included. Moderate and severe PPM was 15.6% and 1.6%, respectively. Cumulative lifetime hazard was worse for biological valves (mortality: biological 77.7% vs. mechanical 64.8%, p = .001). Moderate prosthetic aortic stenosis (AS), (EOA = 1–1.5 cm2) was 12.1% and severe prosthetic AS (EOA ≤ 1 cm2) was 0.8%, respectively. Survival was 10.5 ± 0.4 years with moderate to severe prosthetic AS (EOA≤1.5 cm2) versus 12.6 ± 0.2 years with mild to no prosthetic AS (EOA>1.5 cm2), p = .001. Worse survival in the presence of moderate-severe prosthetic AS was seen with biological valves (9.7 ± 0.4 years vs. 11.2 ± 0.2 years, p = .001 for EOA≤1.5, >1.5 cm2, respectively). Moderate to severe PPM was associated with worse survival (11.1 ± 0.4 years for iEOA ≤ 0.85 cm2/m2 vs. 12.5 ± 0.2 years with iEOA > 0.85 cm2/m2, p = .001). Moderate to severe PPM predicted worse long term survival (hazard ratio: 3.56; 95% confidence interval: 1.37–9.25; p = .009). Conclusion Predicted prosthetic moderate to severe AS and moderate to severe PPM adversely affect long term survival. Smaller valves are associated with reduced survival.
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Luthra et al. (2021) conducted a cohort in Isolated aortic valve replacement (n=3,444). Moderate to severe patient prosthesis mismatch (PPM) vs. Mild to no PPM was evaluated on Long-term survival (HR 3.56, 95% CI 1.37-9.25, p=0.009). Moderate to severe patient prosthesis mismatch predicted worse long-term survival after isolated aortic valve replacement (HR 3.56; 95% CI 1.37-9.25; p=0.009).
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