Impact of Patient-Prosthesis Mismatch on Long-Term Outcomes After Aortic Valve Replacement

This study investigated the impact of patient-prosthesis mismatch (PPM) on long-term mortality and reoperation rates over a 15-year follow-up in patients who underwent biologic aortic valve replacement. A total of 645 patients were included, all of whom had their PPM status evaluated via echocardiographic examinations six months post-surgery, with PPM defined by an indexed effective orifice area of less than 0.85 cm²/m².    Of the patients studied, 256 (40 percent) exhibited PPM, categorized into 175 with moderate PPM and 81 with severe PPM. The analysis revealed that survival rates were not significantly impaired for patients with moderate PPM compared to those without PPM. However, patients with severe PPM demonstrated a marginally significant increase in mortality risk, with a hazard ratio (HR) of 1.40 (95 percent CI, 0.99-1.97; P = .054).    Factors associated with reduced survival included older age (HR, 1.12; P < .001), arterial hypertension (HR, 1.78; P < .001), and diabetes mellitus (HR, 1.67; P < .001). Regarding reoperation rates, there were 10.1 events per 1,000 patient-years for patients without PPM, 8.5 for those with moderate PPM, and 14.8 for those with severe PPM. The 10-year cumulative incidence of reoperation was 8.3 percent, 6.7 percent, and 12.1 percent, respectively.    Notably, multivariable analysis showed that PPM category was not significantly associated with the risk of reoperation (P > .2). In conclusion, while PPM had a marginal relationship with long-term survival, it was not statistically linked to reintervention risk. These findings suggest that other clinical factors may play more crucial roles in patient outcomes after aortic valve replacement.