ISSN 1671-5411 CN 11-5329/R
Volume 17 Issue 8
Sep.  2020
Turn off MathJax
Article Contents
Meng-Wei TAN, Yi-Fan BAI, Xiao-Hong LIU, Zhi-Yun XU, Zhao AN, Ye MA, Li-Bo ZHAO, Bai-Ling LI. Impact of prosthesis-patient mismatch on early and late outcomes after mitral valve replacement: a meta-analysis. J Geriatr Cardiol 2020; 17(8): 455-475. doi: 10.11909/j.issn.1671-5411.2020.08.003
Citation: Meng-Wei TAN, Yi-Fan BAI, Xiao-Hong LIU, Zhi-Yun XU, Zhao AN, Ye MA, Li-Bo ZHAO, Bai-Ling LI. Impact of prosthesis-patient mismatch on early and late outcomes after mitral valve replacement: a meta-analysis. J Geriatr Cardiol 2020; 17(8): 455-475. doi: 10.11909/j.issn.1671-5411.2020.08.003

Impact of prosthesis-patient mismatch on early and late outcomes after mitral valve replacement: a meta-analysis

doi: 10.11909/j.issn.1671-5411.2020.08.003
*The authors contributed equally to this manuscript
More Information
  • Corresponding author: Li-Bo ZHAO, Department of Cardiothoracic Surgery, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China. E-mails:; Bai-Ling LI, Department of Cardiothoracic Surgery, Changhai Hospital, Naval Military Medical University (The Second Military Medical University), Shanghai, China.
  • Received Date: 2020-04-09
  • Accepted Date: 2020-07-20
  • Rev Recd Date: 2020-06-24
  • Available Online: 2020-08-28
  • Publish Date: 2020-09-07
  •  Background Prognostic significance of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) remains uncertain because of the limited studies reporting inconsistent or even contrary results. This meta-analysis pooled results of all available studies comparing early and late prognoses between patients with significant mitral PPM and those without. Methods Studies were identified by searching Pubmed, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, and Impact of PPM on postoperative hemodynamic results, thirty-day mortality, overall mortality, mortality of thirty-day survivors, and primary morbidity after MVR was evaluated via meta-analysis. Robustness of pooled estimates, source of heterogeneity, and publication bias were assessed via sensitivity analyses, meta-regression as well as subgroup analysis stratified according to methodological or clinical heterogeneity, or sequential omission method, and funnel plot or Begg's and Egger's tests, respectively. Results Nineteen cohort studies involving 9302 individuals (PPM group: n = 5109, Control group: n = 4193) were included for meta-analysis. Total PPM and severe PPM prevalence were 3.8%–85.9% and 1%–27%, with a mean value of 54.9% and 14.1%, respectively. As compared with control group, mitral PPM group demonstrated a poorer postoperative hemodynamic status of higher mean and peak residual transprosthetic pressure gradients (TPG), higher postoperative systolic pulmonary artery pressure (SPAP) and less reduction, higher postoperative pulmonary hypertension (PH) prevalence and less PH regression, smaller net atrioventricular compliance, less NYHA class decrease, higher postoperative functional tricuspid regurgitation prevalence and less regression. The PPM group also revealed a higher thirty-day mortality, long-term overall mortality, mortality of thirty-day survivors, and postoperative congestive heart failure prevalence, which were positively correlated with the severity of PPM if it was classified into tri-level subgroups. Left ventricular end-diastolic diameter, postoperative atrial fibrillation (AF) prevalence, and the AF regression were analogous between groups. Most pooled estimates were robust according to sensitivity analyses. Male patients and bioprosthesis implantation proportion were prominent source of between-study heterogeneity on thirty-day mortality. Publication bias was not significant in tests for all the outcomes, except for SPAP and TPG. Conclusions Mitral PPM would result in poorer postoperative hemodynamics and worse early and late prognosis. Severe PPM must be avoided since deleterious impact of mitral PPM was severity dependent.
  • loading
  • [1]
    Rahimtoola SH. The problem of valve prosthesis-patient mis match. Circulation 1978; 58: 20-24. doi: 10.1161/01.CIR.58.1.20
    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 27186 patients with 133141 patient-years. Eur Heart J 2012; 33: 1518-1529. doi: 10.1093/eurheartj/ehs003
    Dumesnil JG, Yoganathan AP. Valve prosthesis hemody na mics and the problem of high transprosthetic pressure gra dients. Eur J Cardiothorac Surg 1992; 6: S34-S38. doi: 10.1093/ejcts/6.Supplement_1.S34
    Leavitt JI, Coats MH, Falk RH. Effects of exercise on trans mitral gradient and pulmonary artery pressure in patients with mitral stenosis or a prosthetic mitral valve: a Doppler echo cardiographic study. J Am Coll Cardiol 1991; 17: 1520-1526. doi: 10.1016/0735-1097(91)90641-L
    Monin JL. Prosthesis-patient mismatch: myth or reality? Heart 2009; 95: 948-952. doi: 10.1136/hrt.2008.151928
    Liao YB, Li YJ, Jun-Li L, et al. Incidence, predictors and out come of prosthesis-patient mismatch after transcatheter aortic valve replacement: a systematic review and meta-analysis. Sci Rep 2017; 7: 15014. doi: 10.1038/s41598-017-15396-4
    Rahimtoola SH, Murphy E. Valve prosthesis--patient mis match. A long-term sequela. Br Heart J 1981; 45: 331-335. doi: 10.1136/hrt.45.3.331
    Dumesnil JG, Honos GN, Lemieux M, et al. Validation and applications of mitral prosthetic valvular areas calculated by Doppler echocardiography. Am J Cardiol 1990; 65: 1443-1448. doi: 10.1016/0002-9149(90)91352-7
    Tanné D, Kadem L, Rieu R, et al. Hemodynamic impact of mitral prosthesis-patient mismatch on pulmonary hyper tension: an in silico study. J Appl Physiol (1985) 2008; 105: 1916-1926. doi: 10.1152/japplphysiol.90572.2008
    Yazdanbakhsh AP, van den Brink RB, Dekker E, et al. Small valve area index: its influence on early mortality after mi tral valve replacement. Eur J Cardiothorac Surg 2000; 17: 222-227. doi: 10.1016/S1010-7940(00)00343-2
    Fernandez J, Chen C, Laub GW, et al. Predictive value of prosthetic valve area index for early and late clinical results after valve replacement with the St Jude Medical valve prosthesis. Circulation 1996; 94: Ⅱ109-Ⅱ112.
    Babin-Ebell J, Schuster C, Elert O, et al. Influence of valve size on morbidity and mortality for patients with mechani cal valve replacements (GELIA 8). Eur Heart J 2001; 3: Q73-Q77. doi: 10.1016/S1520-765X(01)90048-3
    Ammannaya GKK, Mishra P, Khandekar JV, et al. Effect of prosthesis patient mismatch in mitral position on pulmonary hypertension. Eur J Cardiothorac Surg 2017; 52: 1168-1174. doi: 10.1093/ejcts/ezx167
    Sato S, Fujita T, Shimahara Y, et al. Impact of pros thesis- patient mismatch on late recurrence of atrial fibrillation after cryomaze procedure with mitral valve replacement. Circ J 2014; 78: 1908-1914. doi: 10.1253/circj.CJ-14-0431
    Angeloni E, Melina G, Benedetto U, et al. Impact of pros thesis-patient mismatch on tricuspid valve regurgitation and pulmonary hypertension following mitral valve replacement. Int J Cardiol 2013; 168: 4150-4154. doi: 10.1016/j.ijcard.2013.07.116
    Shi WY, Yap CH, 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: 1074-1081. doi: 10.1136/hrt.2010.219576
    Aziz A, Lawton JS, Maniar HS, et al. Factors affecting sur vival after mitral valve replacement in patients with prosthe sis-patient mismatch. Ann Thorac Surg 2010; 90: 1202-1210. doi: 10.1016/j.athoracsur.2010.05.018
    Jamieson WR, Germann E, Ye J, et al. Effect of pros thesis- patient mismatch on long-term survival with mitral valve replacement: assessment to 15 years. Ann Thorac Surg 2009; 87: 1135-1142. doi: 10.1016/j.athoracsur.2009.01.056
    Magne J, Mathieu P, Dumesnil JG, et al. Impact of prosthesis- patient mismatch on survival after mitral valve replacement. Circulation 2007; 115: 1417-1425. doi: 10.1161/CIRCULATIONAHA.106.631549
    Lam BK, Chan V, Hendry P, et al. The impact of patient- prosthesis mismatch on late outcomes after mitral valve re placement. J Thorac Cardiovasc Surg 2007; 133: 1464-1473. doi: 10.1016/j.jtcvs.2006.12.071
    Hwang HY, Sohn SH, Jang MJ. Impact of prosthesis-patient mismatch on survival after mitral valve replacement: a meta- analysis. Thorac Cardiovasc Surg 2019; 67: 538-545. doi: 10.1055/s-0038-1675195
    Page MJ, Moher D. Evaluations of the uptake and impact of the Preferred Reporting Items for Systematic reviews and Meta- Analyses (PRISMA) Statement and extensions: a scoping review. Syst Rev 2017; 6: 263. doi: 10.1186/s13643-017-0663-8
    Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605. doi: 10.1007/s10654-010-9491-z
    Liu DS, Chen J, Jian WM, et al. The association of atrial fibrillation and dementia incidence: a meta-analysis of pro spective cohort studies. J Geriatr Cardiol 2019; 16: 298-306.
    Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for sur vival endpoints. Stat Med 1998; 17: 2815-2834. doi: 10.1002/(SICI)1097-0258(19981230)17:24<2815::AID-SIM110>3.0.CO;2-8
    Spruance SL, Reid JE, Grace M, et al. Hazard ratio in clinical trials. Antimicrob Agents Chemother 2004; 48: 2787-2792. doi: 10.1128/AAC.48.8.2787-2792.2004
    Williamson PR, Smith CT, Hutton JL, et al. Aggregate data meta-analysis with time-to-event outcomes. Stat Med 2002; 21: 3337-3351. doi: 10.1002/sim.1303
    Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560. doi: 10.1136/bmj.327.7414.557
    Peairs KS, Barone BB, Snyder CF, et al. Diabetes mellitus and breast cancer outcomes: a systematic review and meta- analysis. J Clin Oncol 2011; 29: 40-46.
    Twine CP, Williams IM. Systematic review and meta-analysis of the effects of statin therapy on abdominal aortic aneurysms. Br J Surg 2011; 98: 346-353. doi: 10.1002/bjs.7343
    Pisano C, Rita Balistreri C, Fabio Triolo O, et al. Impact of prosthesis-patient mismatch after mitral valve replacement. J Heart Valve Dis 2016; 25: 39-45.
    Cho IJ, Hong GR, Lee SH, et al. Prosthesis-patient mismatch after mitral valve replacement: comparison of different me thods of effective orifice area calculation. Yonsei Med J 2016; 57: 328-336. doi: 10.3349/ymj.2016.57.2.328
    Borracci RA, Rubio M, Sestito ML, et al. Incidence of pro sthesis-patient mismatch in patients receiving mitral Biocor® porcine prosthetic valves. Cardiol J 2016; 23: 178-183. doi: 10.5603/CJ.a2016.0011
    Cao H, Qiu Z, Chen L, et al. Star GK bileaflet mechanical valve prosthesis-patient mismatch after mitral valve replace ment: a Chinese multicenter clinical study. Med Sci Monit 2015; 21: 2542-2546. doi: 10.12659/MSM.894044
    Blauwet LA, Malouf JF, Connolly HM, et al. Comprehensive hemodynamic assessment of 368 normal St. Jude Medical me chanical mitral valve prostheses based on early postimplanta tion echocardiographic studies. J Am Soc Echocardiogr 2013; 26: 381-389. doi: 10.1016/j.echo.2013.01.015
    Ren CL, Gao CQ, Jiang SL, et al. [Prosthesis-patient mis match in the mitral valve position: the initial result of a single-institutional observational study in China]. Zhonghua Wai Ke Za Zhi 2011; 49: 311-314. [In Chinese].
    Matsuura K, Mogi K, Aoki C, et al. Prosthesis-patient mis match after mitral valve replacement stratified by referred and measured effective valve area. Ann Thorac Cardiovasc Surg 2011; 17: 153-159. doi: 10.5761/atcs.oa.10.01558
    Sakamoto H, Watanabe Y. Does patient-prosthesis mismatch affect long-term results after mitral valve replacement? Ann Thorac Cardiovasc Surg 2010; 16: 163-167.
    Bouchard D, Vanden Eynden F, Demers P, et al. Patient-pro sthesis mismatch in the mitral position affects midterm sur vival and functional status. Can J Cardiol 2010; 26: 532-536. doi: 10.1016/S0828-282X(10)70466-9
    Tuğcu A, Köse O, Yildirimtürk O, et al. The frequency of prosthesis-patient mismatch after mechanical mitral valve replacement and its effect on postoperative systolic pulmonary arterial pressure. Turk Kardiyol Dern Ars 2009; 37: 523-530.
    Li M, Dumesnil JG, Mathieu P, et al. Impact of valve pro sthesis-patient mismatch on pulmonary arterial pressure after mitral valve replacement. J Am Coll Cardiol 2005; 45: 1034-1040. doi: 10.1016/j.jacc.2004.10.073
    Shibata T, Inoue K, Ikuta T, et al. Which valve and which size should we use in the valve-on-valve technique for re-do mitral valve surgery? Interact Cardiovasc Thorac Surg 2009; 8: 206-210.
    Ruzicka DJ, Eichinger WB, Hettich IM, et al. Hemodynamic performance of the new St. Jude Medical Epic Supra porcine bioprosthesis in comparison to the Medtronic Mosaic on the basis of patient annulus diameter. J Heart Valve Dis 2008; 17: 426-434.
  • 加载中


    通讯作者: 陈斌,
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(6)  / Tables(2)

    Article Metrics

    Article views (318) PDF downloads(22) Cited by()
    Proportional views


    DownLoad:  Full-Size Img  PowerPoint