The impact of patient-prothesis mismatch on mid-term outcomes in isolated aortic valve replacement

Objective: This study aims to investigate the impact of patient-prosthesis mismatch (PPM) on mid-term outcomes in patients who underwent isolated surgical aortic valve replacement due to severe aortic stenosis. Methods: The preoperative and postoperative data of 91 patients operated on between January 2016 and January 2023 were retrospectively analyzed. The indexed effective orifice area (iEOA) and body mass index (BMI) of the patients were calculated. The severity of PPM was determined according to the "Valve Academic Research Consortium-3" criteria and analyzed in two groups (Insignificant PPM: iEOA> 0.85 cm²/m² for BMI< 30 kg/m², iEOA> 0.70 cm²/m² for BMI≥ 30 kg/m²; Significant PPM: iEOA≤ 0.85 cm²/m² for BMI< 30 kg/m², iEOA≤ 0.70 cm²/m² for BMI≥ 30 kg/m²). The left ventricular (LV) geometries were categorized using the left ventricular mass index (LVMI) and relative wall thickness values. Results: The mean age of the patients was 64.2±8.9 years, with 44% being female. The median change in LVMI was -33 g/m² in the insignificant PPM group compared to -14.5 g/m² in the significant PPM group (p=0.037). In multivariate analysis, a lesser regression in LVMI is associated with a higher likelihood of significant PPM (OR: 1.021, p=0.043). No significant changes were observed in LV geometry within either the significant or insignificant PPM groups, but a significant difference was found between the functional capasity changes (p=0.01). Conclusion: Avoiding significant PPM is beneficial for better regression in LVMI and greater improvement in functional capacity; however, it is not sufficient for a significant change in LV geometry. Keywords: Aortic Valve Stenosis, Heart Valve Prosthesis Implantation, Ventricular Remodeling