Impact of prosthesis-patient mismatch after mitral valve replacement: A propensity score analysis.

Abstract Objective The effect of patient–prosthesis mismatch (PPM) on late outcomes after mitral valve replacement (MVR) remains unclear. We evaluated the impact of PPM after MVR on the late survival using propensity score matching analysis. Methods From 2007 to 2018, 660 consecutive MVRs were performed. Effective orifice areas were obtained from a literature review of in vivo echocardiographic data, and mitral PPM was defined as an effective orifice area index of ≤1.2 cm2/m2. Propensity score matching yielded a cohort of 126 patients with PPM and 126 patients without PPM. Results Mitral PPM was found in 37.8% of the patients. In the whole matched patients, there were no differences in late survival (log-rank test, p=0.629) between two groups. Patients aged ≤70 years and those aged > 70 years had no differences in late survival (log-rank test, p=0.073 and 0.572). The Cox proportional hazards model for the overall survival showed that mitral PPM tended to decrease survival in patients aged ≤ 70 years (p = 0.084, hazard ratio [HR] 2.647, 95% CI: 0.876 to 7.994). Conclusions Mitral PPM did not adversely affect long-term survival. There may be a tendency of adverse impact on late survival in patients aged ≤70 years. Implanting a safe size rather than larger size prosthesis in mitral position may be an appropriate option in older patients.