Impact of Prosthesis‐Patient Mismatch After Surgical Aortic Valve Replacement: Systematic Review and Meta‐Analysis of Reconstructed Time‐to‐Event Data of 122 989 Patients With 592 952 Patient‐Years
Abstract
Background It remains controversial whether prosthesis‐patient mismatch (PPM) impacts long‐term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions. Methods and Results We performed a systematic review with meta‐analysis of reconstructed time‐to‐event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses). Sixty‐five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow‐up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio [HR], 1.16 [95% CI, 1.13–1.18], P<0.001). At 20 years of follow‐up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 [95% CI, 1.06–1.11], P<0.001; severe versus no PPM: HR, 1.29 [95% CI, 1.24–1.35], P<0.001). PPM was associated with higher risk of cardiac death, heart failure–related hospitalizations, and aortic valve reinterventions over time (P<0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 122 participants or records.
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