Any degree of prosthesis-patient mismatch after surgical aortic valve replacement is associated with a 16% increase in the risk of all-cause mortality compared to patients without mismatch (HR 1.16).
Meta-Analysis (n=122,989)
Yes
Does prosthesis-patient mismatch (PPM) increase the risk of mortality, heart failure hospitalizations, and aortic valve reinterventions in patients undergoing surgical aortic valve replacement?
Any degree of prosthesis-patient mismatch after surgical aortic valve replacement is associated with poorer long-term survival and increased risk of heart failure hospitalizations and reinterventions.
Effect estimate: HR 1.16 (95% CI 1.13-1.18)
Absolute Event Rate: 11.8% vs 20.6%
p-value: p=<0.001
Background It remains controversial whether prosthesis‐patient mismatch (PPM) impacts long‐term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions. Methods and Results We performed a systematic review with meta‐analysis of reconstructed time‐to‐event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses). Sixty‐five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow‐up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio HR, 1.16 95% CI, 1.13–1.18, P <0.001). At 20 years of follow‐up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 95% CI, 1.06–1.11, P <0.001; severe versus no PPM: HR, 1.29 95% CI, 1.24–1.35, P <0.001). PPM was associated with higher risk of cardiac death, heart failure–related hospitalizations, and aortic valve reinterventions over time ( P <0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta‐regression analysis revealed that populations with more women tend to have higher HRs for all‐cause death associated with PPM. Conclusions The results of the present study suggest that any degree of PPM is associated with poorer long‐term outcomes following surgical aortic valve replacement and provide support for implementation of preventive strategies to avoid PPM after surgical aortic valve replacement.
Sá et al. (Wed,) conducted a meta-analysis in Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement (n=122,989). Surgical Aortic Valve Replacement (SAVR) vs. No PPM was evaluated on All-cause mortality (HR 1.16, 95% CI 1.13-1.18, p=<0.001). Any degree of prosthesis-patient mismatch after surgical aortic valve replacement is associated with a 16% increase in the risk of all-cause mortality compared to patients without mismatch (HR 1.16).