A1 Refereed original research article in a scientific journal
Patient-Prosthesis Mismatch Mismatch Worsens Long-Term Survival: Insights From the FinnValve Registry
Authors: Dahlbacka Sebastian, Laakso Teemu, Kinnunen Eeva-Maija, Moriyama Noriaki, Laine Mika, Virtanen Marko, Maaranen Pasi, Ahvenvaara Tuomas, Tauriainen Tuomas, Husso Annastiina, Jalava Maina, Jaakkola Jussi, Airaksinen Juhani, Valtola Antti, Niemelä Matti, Mäkikallio Timo, Eskola Markku, Vento Antti, Juvonen Tatu, Biancari Fausto, Raivio Peter
Publisher: Elsevier Inc.
Publication year: 2021
Journal: Annals of Thoracic Surgery
Journal name in source: Annals of Thoracic Surgery
eISSN: 1552-6259
DOI: https://doi.org/10.1016/j.athoracsur.2020.06.026
Background
The impact of patient-prosthesis mismatch (PPM) on long-term outcome after surgical aortic valve replacement (SAVR) is controversial. We sought to investigate the incidence of PPM and its impact on survival and reinterventions in a Finnish nationwide cohort.
Methods
In the context of the nationwide FinnValve registry, we identified 4097 patients who underwent SAVR with a stented bioprosthesis with or without myocardial revascularization. The indexed effective orifice areas (EOAs) of surgical bioprostheses were calculated using literature-derived EOAs. PPM was graded as moderate (EOA 0.65-0.85 cm2/m2) or severe (EOA ≤0.65 cm2/m2).
Results
The incidence of PPM was 46.0%. PPM was moderate in 38.8% (n = 1579) patients and severe in 7.2% (n = 297) patients. Time-trend analysis showed that the proportion of PPM decreased significantly from 74% in 2009 to 18% in 2017 (P < .01). Severe PPM was associated with increased 5-year all-cause mortality (adjusted hazard ratio [HR], 1.72; 95% confidence interval [CI], 1.07-2.76; P = .02). Severe PPM was not associated with an increased risk of repeat AVR (adjusted HR, 5.90; 95% CI, 0.95-36.5; P = .06). In a subanalysis of patients greater than or equal to 70 years of age, in comparison with no PPM, any PPM (adjusted HR, 1.23; 95% CI, 1.05-1.45; P = .01) and severe PPM (HR, 1.53; 95% CI, 1.17-2.00; P < 0.01) were associated with increased risk of 5-year mortality.
Conclusions
Severe PPM after SAVR had a negative impact on survival. This study demonstrated that the effects of PPM should not be overlooked in elderly undergoing SAVR.
