ABSTRACT
Objectives: Patient-prosthesis mismatch (PPM) may impair
functional capacity and survival after aortic valve replacement (AVR). A
mechanical prosthesis tends to have less PPM than a biological
prosthesis, but these differences in clinical outcomes remain unclear.
This study aimed to investigate the impact of PPM on long-term survival
and quality of life (QoL) after mechanical and biological AVRs.
Methods: The presence of PPM was defined in 595 consecutive
patients who had undergone isolated AVR. Patients were divided into two
groups according to whether they had received a biological or mechanical
prosthesis. The groups with and without PPM present were compared with
regard to baseline characteristics, operative characteristics, survival,
severe complications, freedom from angina and QoL up to 6 years of
follow-up. PPM calculation was performed using the EOA value provided by
the manufacturer for every prosthesis divided by the patient’s body
surface area.
Results: The moderate-to-severe PPM rates were 69.8% and 3.7%
after biological and mechanical prostheses implantation, respectively.
Patients with a biological prosthesis implanted had mean survival
significantly shorter in the PPM group (50.2 months, 95% confidence
interval [CI] 45.2-55.3) when compared to the no-PPM group (60.1
months, 95% CI 55.7-64.4) (p = 0.035). In the mechanical prosthesis
group, there was no difference in mean survival between the PPM group
(66.6 months, 95% CI 58.3-74.9) when compared to the no-PPM group (64.9
months, 95% CI 62.6-67.2) (p = 0.50). The physical score of the QoL
questionnaire was significantly lower in the PPM group when compared to
the no-PPM group with a biological prosthesis (39.4 ± 8.4 vs. 45.7 ±
10.1, p < 0.001) compared to patients with a mechanical
prosthesis (43.9 ± 9.4 vs. 46.9 ± 8.3, p = 0.18).
Conclusions: PPM is common after biological valve implantation
and significantly impacts long-term survival and QoL. If the risk of PPM
after implantation of a biological prosthesis is suspected, prospective
strategies to avoid PPM at the time of operation are warranted.
Keywords: Patient-prosthesis mismatch, survival, quality of
life, surgical aortic valve replacement, mechanical prosthesis,
biological prosthesis