Abstract Body (Do not enter title and authors here): Importance: Prosthesis-Patients Mismatch (PPM) is associated with multiple adverse event after aortic valve replacement (AVR), especially increased long-term mortality. Despite women are more likely to have PPM, sex-differences in PPM outcomes remain poorly explored.
Objectives: To evaluate PPM incidence and sex-differences in PPM impact in a large cohort of patients underwent surgical aortic valve replacement.
Design, Setting and Participants: We included 7,319 patients who underwent Surgical AVR between 2000 and 2021. PPM was defined accordingly to Valve-Academic-Research-Consortium-3 criteria, adopting correction for Body Surface Area >30 kg/m2 and retrieving the predicted effective orifice area of the aortic valve prosthesis. The cohort was followed up prospectively from Surgical AVR until November 2023.
Main Outcomes and Measures: Primary endpoint was defined as long-term mortality and secondary endpoint as long-term cardiovascular (CV) mortality. Mortality was established and Cardiovascular mortality adjudicated by Quebec national database.
Results. Severe PPM incidence was rare (1.1%), more prevalent in women (2.5%) than in men (0.5%, p<0.0001). Any-degree-PPM (22.8% of patients) was also more prevalent in women (31.9% vs. 19.7%, p<0.0001). Over a median follow-up of 13 years, there was 3,231 (44.1%) all-cause deaths, with 1,238 (16.9%) being from CV causes. PPM was associated to excess mortality (HR:1.30[1.20-1.40]; p<0.0001) and CV mortality (HR: 1.39[1.23-1.57]; p<0.0001) in the whole cohort without interaction between sexes (p=0.94 and p=0.74). After comprehensive multivariable adjustment, PPM resulted an independent predictor of long-term mortality and CV mortality in women (both p≤0.04) but no in men (both p≥0.66).
Conclusion and relevance: In this large series of AVR patients, PPM was more prevalent in women, in whom it was an independent predictor of mortality. This finding suggests that sex-specific management of aortic valve intervention may be of importance and warrants further studies focusing on this aspect.