Key result
Mitral prosthesis-patient mismatch was not associated with adverse atrial or ventricular remodeling, late tricuspid regurgitation progression, or decreased survival in a rheumatic population.
Why the study?
Does prosthesis-patient mismatch after mitral valve replacement worsen late clinical outcomes and survival in patients with rheumatic heart disease?
Cohort (n=445)
No
Does prosthesis-patient mismatch after mitral valve replacement worsen late clinical outcomes and survival in patients with rheumatic heart disease?
Absolute Event Rate: 94% vs 94%
p-value: p=0.7
In patients with rheumatic heart disease, prosthesis-patient mismatch after mitral valve replacement does not appear to negatively impact long-term survival, atrial/ventricular remodeling, or tricuspid regurgitation progression.
Supports tolerance of mismatch without remodeling or survival impact in rheumatic MVR; leaves open randomized confirmation.
BACKGROUND: Prosthesis-patient mismatch (PPM) is characterised by the effects of inadequate prosthesis size relative to body surface area (BSA).The purpose of this study was to determine the impact of PPM on late clinical outcomes after mitral valve replacement (MVR) in rheumatic population. METHODS: . Clinical and echocardiographic follow-up (mean follow up 8.7 ± 4.0 years) results were compared. RESULTS: 37% of patients (n = 165) had PPM. There were no significant differences in baseline and operative characteristics between patients with and without PPM except age and IEOA. A significant decrease in mean trans-valvular pressure gradient (MPG) over time following MVR, however the change of MPG showed no differences between groups (No PPM vs. PPM: 8.9 ± 4.7 mmHg → 3.6 ± 1.2 mmHg vs. 8.7 ± 4.5 mmHg → 3.8 ± 1.4 mmHg, p-value = 0.28). In all patients, there was a reduction of left atrium dimension (58.6 ± 12.0 mm → 53.2 ± 12.0 mm vs. 57.9 ± 8.9 mm → 52.2 ± 8.9 mm, p-value = 0.68) and left ventricular end diastolic diameter (49.9 ± 5.7 mm → 48.9 ± 5.7 mm vs. 49.7 ± 6.0 mm → 48.3 ± 5.0 mm, p = 0.24) without statistical significance. Freedom from TR progression rates at 3 and 5 years (99% vs.98%, 99% vs. 98%, p-value = 0.1), and overall survival rates at 3 and 5 years (97% vs. 96%, 94% vs. 94%, p-value = 0.7) were similar. CONCLUSION: This study shows that mitral PPM is not associated with atrial /ventricular remodeling and might not influence late clinical outcome including late TR progression, survival in rheumatic population.
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Lee et al. (2017) conducted a cohort in Rheumatic mitral valve disease (n=445). Prosthesis-patient mismatch (indexed EOA ≤ 1.2 cm2/m2) vs. No prosthesis-patient mismatch (indexed EOA > 1.2 cm2/m2) was evaluated on 5-year overall survival (p=0.7). Mitral prosthesis-patient mismatch was not associated with adverse atrial or ventricular remodeling, late tricuspid regurgitation progression, or decreased survival in a rheumatic population.
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