Prosthesis–patient mismatch after aortic valve replacement predominantly affects patients with preexisting left ventricular dysfunction: Effect on survival, freedom from heart failure, and left ventricular mass regression

ObjectiveThe effect of prosthesis–patient mismatch on clinical outcome and left ventricular mass regression after aortic valve replacement remains controversial. Data on whether the clinical effect of prosthesis–patient mismatch depends on left ventricular function at the time of aortic valve replacement are lacking. This study examined the long-term clinical and echocardiographic effects of prosthesis–patient mismatch in patients with and without left ventricular systolic dysfunction at the time of aortic valve replacement.MethodsPreoperative and serial postoperative echocardiograms were performed in 805 adults who underwent aortic valve replacement between 1990 and 2003 and who were subsequently followed up in a dedicated valve clinic (follow-up, mean ± SD, 5.5 ± 3.5 years; maximum, 14.2 years). Preoperative left ventricular function was defined as normal (ejection fraction ≥50%) in 548 patients and impaired (ejection fraction