Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials.

Abstract

Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm²/m²) or severe (indexed effective orifice area ≤0.65 cm²/m²). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. By the predicted PPM method (PPM_P), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPM_M), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPM_P (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPM_P (38.8%, P = .02). Using the PPM_M method, there was no difference between the no (17.7%) and moderate PPM_M groups (21.1%) in the primary outcome (P = .16). However, those with no PPM_M or moderate PPM_M were improved compared with severe PPM_M (27.4%, P < .001 and P = .02, respectively). Severe PPM analyzed by PPM_P was only 2.1% for surgical aortic valve replacement patients. The PPM_M method overestimated the incidence of severe PPM relative to PPM_P, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.