Download PDF
Thorac Cardiovasc Surg 2019; 67(07): 538-545
DOI: 10.1055/s-0038-1675195
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Impact of Prosthesis-Patient Mismatch on Survival after Mitral Valve Replacement: A Meta-analysis

Ho-Young Hwang
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
,
Suk-Ho Sohn
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
,
Myoung-jin Jang
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
› Author Affiliations Funding No source of funding.
Further Information

Publication History

13 July 2018

20 August 2018

Publication Date:
09 October 2018 (online)

    Permissions and Reprints All articles of this category

Abstract

Background Numerous studies have demonstrated a negative impact of prosthesis-patient mismatch (PPM) on long-term clinical outcomes after aortic valve replacement. However, the impact of PPM after mitral valve replacement (MVR) on clinical outcomes is still controversial. This study was conducted to evaluate the impact of PPM on early and long-term survival after MVR.

Methods A literature search of five databases was performed. The primary and secondary outcomes were all-cause mortality and early mortality, respectively. Subgroup analyses were performed according to the risk of bias, patients' age, proportion of female patients, and proportion of patients with mechanical MVR.

Results Eleven nonrandomized studies including 8,072 patients were included in this meta-analysis. The overall incidence of PPM was 58.0% (range: 10.4–85.9%). The odds ratio of early mortality in nine studies was not significantly different between the PPM and non-PPM patients (odds ratio: 1.35; 95% confidence interval [CI]: 0.98–1.86). A pooled analysis in 11 studies demonstrated that all-cause mortality after MVR was higher in the PPM than non-PPM patients (hazard ratio [HR]: 1.39; 95% CI: 1.09–1.77). This analysis revealed a moderate to high heterogeneity (I 2 = 69.4%). When pooled analyses were performed in two subgroups according to the proportion of patients with mechanical MVR, there were low heterogeneity in each group. No other subgroup analyses demonstrated a significant difference in the HR of all-cause mortality. Funnel plots and Egger's tests showed no visually and statistically significant publication bias.

Conclusion The present meta-analysis indicates that PPM negatively affects long-term survival after MVR.

Keywords

mitral valve - surgery - heart valve - outcomes - mortality
 

  • References

  • 1 Rahimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation 1978; 58 (01) 20-24
    CrossrefPubMedSearch in Google Scholar
  • 2 Rao V, Jamieson WRE, Ivanov J, Armstrong S, David TE. Prosthesis-patient mismatch affects survival after aortic valve replacement. Circulation 2000; 102 (19, suppl 3): III5-III9
    CrossrefPubMedSearch in Google Scholar
  • 3 Head SJ, Mokhles MM, Osnabrugge RL. , et al. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J 2012; 33 (12) 1518-1529
    CrossrefPubMedSearch in Google Scholar
  • 4 Rahimtoola SH, Murphy E. Valve prosthesis--patient mismatch. A long-term sequela. Br Heart J 1981; 45 (03) 331-335
    CrossrefPubMedSearch in Google Scholar
  • 5 Lam BK, Chan V, Hendry P. , et al. The impact of patient-prosthesis mismatch on late outcomes after mitral valve replacement. J Thorac Cardiovasc Surg 2007; 133 (06) 1464-1473
    CrossrefPubMedSearch in Google Scholar
  • 6 Sato S, Fujita T, Shimahara Y, Hata H, Kobayashi J. Impact of prosthesis-patient mismatch on late recurrence of atrial fibrillation after cryomaze procedure with mitral valve replacement. Circ J 2014; 78 (08) 1908-1914
    CrossrefPubMedSearch in Google Scholar
  • 7 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8 (05) 336-341
    CrossrefPubMedSearch in Google Scholar
  • 8 Wells GA, Shea B, O' Connell D. , et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Accessed April 25, 2017
    PubMedSearch in Google Scholar
  • 9 Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 2007; 8: 16
    CrossrefPubMedSearch in Google Scholar
  • 10 Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ 2011; 342: d671
    CrossrefPubMedSearch in Google Scholar
  • 11 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
    CrossrefPubMedSearch in Google Scholar
  • 12 Copas J, Shi JQ. Meta-analysis, funnel plots and sensitivity analysis. Biostatistics 2000; 1 (03) 247-262
    CrossrefPubMedSearch in Google Scholar
  • 13 Magne J, Mathieu P, Dumesnil JG. , et al. Impact of prosthesis-patient mismatch on survival after mitral valve replacement. Circulation 2007; 115 (11) 1417-1425
    CrossrefPubMedSearch in Google Scholar
  • 14 Jamieson WR, Germann E, Ye J. , et al. Effect of prosthesis-patient mismatch on long-term survival with mitral valve replacement: assessment to 15 years. Ann Thorac Surg 2009; 87 (04) 1135-1141 , discussion 1142
    CrossrefPubMedSearch in Google Scholar
  • 15 Aziz A, Lawton JS, Maniar HS, Pasque MK, Damiano Jr RJ, Moon MR. Factors affecting survival after mitral valve replacement in patients with prosthesis-patient mismatch. Ann Thorac Surg 2010; 90 (04) 1202-1210 , discussion 1210–1211
    CrossrefPubMedSearch in Google Scholar
  • 16 Bouchard D, Vanden Eynden F, Demers P. , et al. Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status. Can J Cardiol 2010; 26 (10) 532-536
    CrossrefPubMedSearch in Google Scholar
  • 17 Sakamoto H, Watanabe Y. Does patient-prosthesis mismatch affect long-term results after mitral valve replacement?. Ann Thorac Cardiovasc Surg 2010; 16 (03) 163-167
    PubMedSearch in Google Scholar
  • 18 Matsuura K, Mogi K, Aoki C, Takahara Y. Prosthesis-patient mismatch after mitral valve replacement stratified by referred and measured effective valve area. Ann Thorac Cardiovasc Surg 2011; 17 (02) 153-159
    CrossrefPubMedSearch in Google Scholar
  • 19 Shi WY, Yap C-H, Hayward PA. , et al. Impact of prosthesis--patient mismatch after mitral valve replacement: a multicentre analysis of early outcomes and mid-term survival. Heart 2011; 97 (13) 1074-1081
    CrossrefPubMedSearch in Google Scholar
  • 20 Borracci RA, Rubio M, Sestito ML, Ingino CA, Barrero C, Rapallo CA. Incidence of prosthesis-patient mismatch in patients receiving mitral Biocor® porcine prosthetic valves. Cardiol J 2016; 23 (02) 178-183
    CrossrefPubMedSearch in Google Scholar
  • 21 Hwang HY, Kim YH, Kim KH, Kim K-B, Ahn H. Patient-prosthesis mismatch after mitral valve replacement: a propensity score analysis. Ann Thorac Surg 2016; 101 (05) 1796-1802
    CrossrefPubMedSearch in Google Scholar
  • 22 Li M, Dumesnil JG, Mathieu P, Pibarot P. Impact of valve prosthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement. J Am Coll Cardiol 2005; 45 (07) 1034-1040
    CrossrefPubMedSearch in Google Scholar
  • 23 Masuda M, Kado H, Tatewaki H, Shiokawa Y, Yasui H. Late results after mitral valve replacement with bileaflet mechanical prosthesis in children: evaluation of prosthesis-patient mismatch. Ann Thorac Surg 2004; 77 (03) 913-917
    CrossrefPubMedSearch in Google Scholar
  • 24 Pibarot P, Dumesnil JG. Prosthesis-patient mismatch in the mitral position: old concept, new evidences. J Thorac Cardiovasc Surg 2007; 133 (06) 1405-1408
    CrossrefPubMedSearch in Google Scholar
  • 25 Zhang J-F, Wu Y-C, Shen W-F, Kong Y. Impact of prosthesis-patient mismatch on survival after mitral valve replacement: a systematic review. Chin Med J (Engl) 2013; 126 (19) 3762-3766
    PubMedSearch in Google Scholar