Sex-Related Differences in Prosthesis-Patient Mismatch Following Aortic Valve Replacement with the Edwards Intuity Valve System

Muhammad Jawoosh¹Rashad Zayat^1*Leyla Dogan¹Yusuf Shieba²Ajay Moza¹Lachmandath Tewarie¹Shahram Lotfi¹Mohammad Amen Khattab¹Ahmad Abugameh^3,4Ahmad F A Mohammed^1,5

• ¹Universitatsklinikum Aachen, Aachen, Germany
• ²Department of Cardiothoracic Surgery, Faculty of Medicine, South Valley University, Qena, Egypt
• ³Klinikum Dortmund gGmbH, Dortmund, Germany
• ⁴Universitat Witten/Herdecke, Witten, Germany
• ⁵South Valley University Faculty of Medicine, Qena, Egypt

Background: Prosthesis-patient mismatch (PPM) is linked to a poor prognosis following surgical aortic valve replacement (SAVR). The exploration of sex differences in PPM outcomes is currently limited. This study seeks to assess the sex-specific effects of PPM following SAVR was rapid deployment AV (RDAVR) prosthesis the Edwards Intuity. Methods: From 2018 to 2023, a total of 256 patients (60 females and 196 males) who received isolated or combined RDAVR at our institution were included. The definition of PPM was established through the use of the indexed effective orifice area (EOAi) in accordance with the Valve Academic Research Consortium-3 (VARC-3) criteria. A Multivariate logistic regression was performed to identify predictors of any degree PPM. Results: Female had higher left ventricular ejection fraction preoperatively (p=0.018). The incidence of any PPM-degree for patients with BMI<30 Kg/cm2 was significantly higher in female than in male (33 (55%) vs. 26(13.3%), p<0.001). The same was noted for the incidence of PPM in patients with BMI≥30 Kg/cm2 (7 (11.7%) vs. 4 (2.0%), p=0.004). And the incidence of severe PPM (EOAi≤0.65 cm²/m²) for patients with BMI<30 Kg/cm2 was 16.7% in females vs. 0 in males (p < 0.001). The in-hospital mortality did not differ between males and females. In the multivariate logistic regression, we could not identify independent predictors of PPM. Conclusions: In Patients receiving RDAVR, the incidence of PPM was significantly higher in female than in male. However, we did not find a correlation with early clinical outcomes. The incidence of severe PPM after RDAVR was low in both females and males. Due to differences in geometry and function of the LV in women, further studies are necessary to indicate whether the definition of PPM in men may adhere to elevated EOAi thresholds compared to women.