Influence of prosthesis – patient mismatch on long-term results in patients after aortic valve replacement with a biological prosthesis: retrospective single center study

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Abstract

Background. Despite numerous studies, ambiguity remains at present regarding the impact of prosthesis-patient mismatch (PPM) on long-term outcomes after aortic valve (AV) replacement.

Objective. This study evaluates the effect of PPM on long-term results in patients after AV replacement with a biological prosthesis.

Material and methods. We retrospectively analyzed the data of 231 patients who underwent AV replacement with a biological prosthesis from 2010 to 2018 at the Penza Federal Center of Cardiovascular Surgery. Patients were implanted with the following biological prostheses: Medtronic Mosaic, Edwards PERIMOUNT, Biocor.

Results. Moderate PPM was present in 131 patients (56%), and severe PPM in 1 patient (0.7%). The mean follow-up was 78.8±32 months. There were no significant differences in hospital mortality in patients with and without PPM, 4 (3%) and 3 (2,9%), respectively, p=0.9. In the long-term period, patients with PPM showed a slower regression of left ventricle (LV) mass and recovery of LV contractile function than patients without PPM, p=0.05. There was no significant difference in survival in the long-term follow-up period between patients with and without PPM long-term survival, 77.7% and 79%, respectively, p=0.6. Also, there were no significant differences in major adverse cardiac events and the freedom from adverse events was 90% and 91%; p=0.7. However, there was a tendency to more frequent hospitalization for chronic heart failure (CHF) exacerbation in the patient group with PPM than in those without PPM, 63.8% and 78%; HR 1.6; 95% CI 0.93–2.1, p=0.007. There was also a tendency for an increased biological valve structural degeneration in the group with PPM than in the group without PPM 76% and 87%, HR 1.4; 95% CI 1.4–3.1, p=0.01 According to the Cox regression, the overall postoperative mortality predictors were diabetes mellitus, vascular atherosclerosis HR 5; 95% CI 1.2–22, p=0.04 and HR 2.9; 95% CI 1.4–6.6, p=0.01 respectively. Predictors of the risk of hospitalization due to CHF exacerbation were previous myocardial infarction and PPM HR 0.4; 95% CI 0.2–0.9, p=0.04 and HR 1,5; 95% CI 0.9–2; p=0.005, respectively PPM HR 2; 95% CI 0.85–4.1, p=0.01.

Conclusion. PPM is a common complication after AV replacement with a biological prosthesis. It is associated with a slower regression of LV mass, an increased risk of structural valve degeneration, and hospitalizations for exacerbated heart failure.

About the authors

Vladlen V. Bazylev

Federal Center of Cardiovascular Surgery

Email: cardio-penza@yandex.ru
ORCID iD: 0000-0001-6089-9722

MD, D. Sci. (Med.), Prof., cardiovascular surgeon, chief physician

 

Russian Federation, Penza

Dmitriy S. Tungusov

Federal Center of Cardiovascular Surgery

Email: cardio-penza@yandex.ru
ORCID iD: 0000-0001-9272-7423

MD, Cand. Sci. (Med.), cardiovascular surgeon, deputy chief physician
Russian Federation, Penza

Ruslan M. Babukov

Federal Center of Cardiovascular Surgery

Email: ruslan.babukov@mail.ru
ORCID iD: 0000-0002-7338-9462

cardiologist, ultrasound doctor

Russian Federation, Penza

Fedor L. Bartosh

Federal Center of Cardiovascular Surgery

Email: cardio-penza@yandex.ru
ORCID iD: 0000-0001-5482-3211

MD, Cand. Sci. (Med.), department head

Russian Federation, Penza

Artur I. Mikulyak

Federal Center of Cardiovascular Surgery

Email: cardio-penza@yandex.ru
ORCID iD: 0000-0002-9519-5036

MD, Cand. Sci. (Med.), cardiovascular surgeon, department head

Russian Federation, Penza

Alena V. Levina

Federal Center of Cardiovascular Surgery

Author for correspondence.
Email: goralen1@mail.ru
ORCID iD: 0000-0002-3210-3974

ultrasound doctor

Russian Federation, Penza

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Supplementary files

Supplementary Files
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2. Fig. 1. Freedom from lethality (Kaplan–Meier analysis).

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3. Fig. 2. Freedom from the development of major vascular events (Kaplan–Meier analysis).

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4. Fig. 3. Freedom from re-hospitalization for exacerbation of chronic heart failure (Kaplan–Meier analysis).

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5. Fig. 4. Freedom from structurally degenerative changes in a biological prosthesis (Kaplan–Meier analysis).

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6. Fig. 5. A scale of the importance of factors influencing the structural degeneration of a biological prosthesis (neural networks).

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