Impact of different values of prosthesis-patient mismatch on outcome in male patients with aortic valve replacement.

Aims Mortality and left ventricular mass (LVM) recovery/regression after aortic valve replacement in patients with prosthesis-patient mismatch (PPM) is controversial. This study evaluated the impact of different values of indexed effective orifice area (EOAi) in male patients on mortality and indexed LVM (ILVM) recovery/regression. Method The study recruited 376 male patients with and without PPM after aortic valve replacement with different EOAi cut-off values. Results At EOAi 0.85 cm2/m2 or less, 295 patients had PPM (78.5%). ILVM recovery occurred in 60.5% of no-PPM patients versus 46.1% of patients with PPM (P = 0.003), and ILVM regression was 35 versus 25% (P < 0.001). Time for ILVM regression was shorter in no-PPM group. At EOAi 0.75 cm2/m2 or less, 201 patients had PPM (53.4%). ILVM recovery occurred in 55.4% of no-PPM patients versus 45.2% of patients with PPM (P = 0.06), regression was 32 versus 29% (P = 0.09). Time for ILVM regression was similar between groups. Regardless the cut-off value for PPM definition, mortality was similar. Conclusion LVM recovery/regression, but not mortality, was different at different EOAi. The cut-off value at EOAi 0.75 cm2/m2 or less guaranteed a more balanced patient distribution between groups and the best compromise between specificity and sensitivity