NDLI: The effect of patient-prosthesis mismatch on survival after aortic and mitral valve replacement: a 10 year, single institution experience

Content Provider	Springer Nature : BioMed Central
Author	Das De, Sudeep Nanjappa, Ashok Morcos, Karim Aftab, Sadia Butler, John Pathi, Vivek Curry, Philip Nair, Sukumaran
Abstract	Background The evidence on the impact of patient-prosthesis Mismatch (PPM) on survival thus far has been conflicting. The aim of this study was to 1) study the effect of PPM on survival after isolated aortic and mitral valve replacement and 2) Assess the interaction between left ventricular function and PPM on survival. Methods The study cohort was patients who underwent isolated Aortic valve replacement (AVR) and Mitral valve replacement (MVR) over a 10-year period from 2008 to 2018. PPM was defined using the projected indexed effective orifice area (EOAi). The cohort was divided into different groups based on the degree of PPM. The severity of PPM was classified using threshold values of EOAi used in the literature. The Kaplan- Meier method was used to compare survival by degree of PPM. Multivariate Cox proportional hazards models were used to generate adjusted hazard ratios (HR) with 95% confidence intervals. An interactive term for ejection fraction (EF) was added to test whether EF modifies the effect of the PPM grade on survival. In addition, sub-group analysis based on left ventricular function was performed. Results In the AVR cohort, there were a total of 1953 patients. The distribution of patients in the different PPM categories was as follows: no PPM 59.7%; moderate PPM 36.8%; severe PPM 3.5%. There was no significant difference in survival between the different groups. At 10 years, the adjusted HR between patients with severe PPM versus no PPM was 1.1(CI 0.5–2.4, p > 0.05) and the HR between those with moderate PPM versus no PPM was 0.97 (CI 0.74–1.23, p > 0.05). In the MVR cohort, there were a total of 298 patients. The distribution of PPM is as follows: no PPM 59.4%; and with PPM 40.6%. Again, there was no significant difference in survival between the groups. At 5 years, the adjusted HR between patients with PPM versus no PPM was 1.45 (CI 0.67–3.14, p > 0.05). In both groups, there was no significant interaction between left ventricular function (LVF) and degree of PPM on survival. Conclusions In our study cohort, the degree of PPM was not an independent predictor of survival after AVR or MVR. There was also no significant interaction between LV function and degree of PPM on survival.
Related Links	https://cardiothoracicsurgery.biomedcentral.com/counter/pdf/10.1186/s13019-019-1034-4.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	17498090
DOI	10.1186/s13019-019-1034-4
Journal	Journal of Cardiothoracic Surgery
Issue Number	1
Volume Number	14
Language	English
Publisher	BioMed Central
Publisher Date	2019-12-06
Access Restriction	Open
Subject Keyword	Cardiac Surgery Thoracic Surgery Aortic valve Mitral valve Survival
Content Type	Text
Resource Type	Article
Subject	Surgery Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine
Journal Impact Factor	1.5/2023
5-Year Journal Impact Factor	1.6/2023

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