Patient–Prosthesis Mismatch in Patients Undergoing Bioprosthetic Aortic Valve Implantation Increases Risk of Reoperation for Structural Valve Deterioration

Objectives: Patient-prosthesis mismatch has been identified as a risk factor for mortality after aortic valve replacement and for structural valve deterioration (SVD) in patients receiving a bioprosthetic aortic valve. The aim of the present study was to compare the incidence of aortic valve bioprosthesis replacement for SVD in patients with mismatch to a population without mismatch. Methods: Three hundred eighty-seven adult patients who underwent aortic valve replacement with a bioprosthesis from 1974 to 2009 were retrospectively reviewed. Mismatch was considered to be present if the anticipated indexed effective orifice area was <0.70cm 2 /m 2 . The median follow-up period was 7.2 years. Follow-up was 97% complete. Results: Patient-prosthesis mismatch was present in 12% of the study population (n=47). Ten-year freedom from reoperation for aortic bioprosthesis replacement was 74.3W3.2%. During follow-up, 111 patients underwent reoperation for aortic bioprosthesis replacement. Causes of aortic bioprosthesis replacement were SVD of the bioprosthesis (n=96), paravalvular leak (n=10), and acute endocarditis (n=5). According to unadjusted Kaplan-Meier analysis, patients with mismatch had a higher incidence of aortic bioprosthesis replacement for SVD when compared with patients without mismatch (log rank test: p 0.05). This result was confirmed by multivariable Cox regression analysis, which identified two independent predictors of aortic bioprosthesis replacement for SVD: patients' age (hazard ratio (HR) 0.967) and patient-prosthesis mismatch (HR 2.161). Conclusion: Patients suffering from mismatch were twice as likely to undergo reoperation for aortic bioprosthesis replacement for SVD than those without mismatch. doi: 10.1111/jocs.12345 (J Card Surg 2014;XX:1-6)