Key result
Prosthesis-patient mismatch after mitral valve replacement was not associated with increased 30-day mortality (5% absent vs 5% moderate vs 6% severe, P=0.83) or reduced 7-year survival.
Why the study?
Does prosthesis-patient mismatch impact early outcomes and mid-term survival in patients undergoing mitral valve replacement?
Cohort (n=1,006)
Yes
Does prosthesis-patient mismatch impact early outcomes and mid-term survival in patients undergoing mitral valve replacement?
Absolute Event Rate: 6% vs 5%
p-value: p=0.83
Prosthesis-patient mismatch after mitral valve replacement is not associated with poorer early outcomes or mid-term survival, suggesting that aggressive oversizing of valves may not be necessary.
Should not yet alter mitral prosthesis sizing; leaves open whether randomized data would confirm survival neutrality.
BACKGROUND: Prosthesis-patient mismatch (PPM) is characterised by the effects of inadequate prosthesis size relative to body surface area (BSA). It is uncertain whether PPM after mitral valve replacement impacts upon clinical outcome. This was examined in an Australian population. METHODS: From 2001 to 2009, 1006 mechanical and bioprosthetic mitral valves were implanted across 10 institutions. Effective orifice areas (EOA) were obtained from a literature review of in vivo echocardiographic data. Absent, moderate and severe PPM was defined as an indexed EOA (EOA/BSA) of >1.20 cm(2)/m(2), >0.90 to ≤1.20 cm(2)/m(2) and ≤0.9 cm(2)/m(2), respectively. Early outcomes and 7-year survival were compared between these three groups. RESULTS: PPM was absent in 34%, moderate in 53% and severe in 13% of patients. Patients with PPM were more likely to be male (42% vs 52% vs 62%, p<0.0001) and obese (14% vs 20% vs 56%, p<0.0001). Postoperatively there was similar 30-day mortality (5% vs 5% vs 6%, p=0.83) and early any mortality/morbidity (24% vs 27% vs 29%, p=0.40). Seven-year survival was similar between groups (72±4.1% vs 76±3.2% vs 69±10.3%, p=0.76). PPM did not predict adverse events after logistic and Cox regressions with and without propensity score adjustment. Subgroup analyses of those with isolated mitral valve surgery, patients with preoperative congestive heart failure and non-obese patients failed to show an association between PPM and mid-term mortality. CONCLUSIONS: Overall, PPM was not associated with poorer early outcomes or mid-term survival. Oversizing valves may be technically hazardous and do not yield superior outcomes. Easier implantation by appropriate sizing appears justified.
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Shi et al. (2011) conducted a cohort in Mitral valve replacement (n=1,006). Prosthesis-patient mismatch vs. Absent prosthesis-patient mismatch was evaluated on 30-day mortality (p=0.83). Prosthesis-patient mismatch after mitral valve replacement was not associated with increased 30-day mortality (5% absent vs 5% moderate vs 6% severe, P=0.83) or reduced 7-year survival.
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