loading page

Clinical impact of patient-prosthesis mismatch after aortic valve replacement with a mechanical or biological prosthesis
  • +5
  • Milos Matkovic,
  • Nemanja Aleksic,
  • Ilija Bilbija,
  • Ana Antic,
  • Jelena Milin,
  • Marko Cubrilo,
  • Aleksandar Milojevic,
  • Svetozar Putnik
Milos Matkovic
Univerzitetski klinicki centar Srbije

Corresponding Author:[email protected]

Author Profile
Nemanja Aleksic
Univerzitetski klinicki centar Srbije
Author Profile
Ilija Bilbija
Univerzitetski klinicki centar Srbije
Author Profile
Ana Antic
Univerzitetski klinicki centar Srbije
Author Profile
Jelena Milin
Univerzitet u Beogradu Medicinski fakultet
Author Profile
Marko Cubrilo
Univerzitetski klinicki centar Srbije
Author Profile
Aleksandar Milojevic
Univerzitetski klinicki centar Srbije
Author Profile
Svetozar Putnik
Univerzitetski klinicki centar Srbije
Author Profile

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.