Patient‐prosthesis mismatch and surgical aortic valve replacement outcomes: Retrospective analysis of single‐center surgical data

• Published in: Journal of cardiac surgery Vol. 36; no. 8; pp. 2805 - 2815
• Main Authors: Gupta, Aurinjoy, Aliter, Hashem, Theriault, Chris, Chedrawy, Edgar
• Format: Journal Article
• Language: English
• Published: United States 01.08.2021
• Subjects: aortic valve replacement; Prosthesis‐patient mismatch; reoperation; valve repair/replacement; Prosthesis-patient mismatch; reoperation; valve repair/replacement; aortic valve replacement
• ISSN: 0886-0440; 1540-8191
• DOI: 10.1111/jocs.15658

Background Patient‐prosthesis mismatch (PPM) has been identified as a risk factor for mortality and reoperation in patients undergoing surgical aortic valve replacement (SAVR). We present a retrospective analysis of risk factors for PPM and the effects of PPM on early postoperative outcomes after SAVR. Methods Chart review was conducted for patients (N = 3003) undergoing SAVR. PPM was calculated from valve reference orifice areas and patient body surface area. Logistic regression was used to analyze risk factors for PPM and develop a risk score from these results. Regression was also conducted to identify associations between projected PPM status and postoperative outcomes. Results Risk factors for PPM included female sex, higher body mass index (BMI), and use of the St. Jude Epic valve. Patients receiving St. Jude trifecta valves or mechanical valves were less likely to have predicted PPM. We developed a risk score using BMI, sex, and valve type, and retrospectively predicted PPM in our cohort. Mild PPM (odds ratio [OR] = 2.267), severe PPM (OR = 2.869), male sex (OR = 2.091), and younger age (OR = 0.940) were all predictors of SAVR reoperation, while aortic root replacement was associated with reduced reoperation rates (OR = 0.122). Severe PPM carried a risk of in‐hospital mortality (OR = 3.599), and moderate PPM carried a smaller but significant risk (OR = 1.920). Other factors increasing postoperative morbidity and mortality included older age, renal failure, and diabetes. Conclusion PPM could be retrospectively predicted in our cohort using a risk calculation from sex, BMI and valve type. We conclude that all degrees of PPM carry risk for mortality and reoperation.