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
