Authors
Nicolò Azzola Guicciardi, Roberto Lorusso, Sofia Pavan, Benedetto Del Forno, Davide Margonato, Vincenzo Rizza, Andrea Mariani, Matteo Mazzola, Alessandro Castiglioni, Ottavio Alfieri, Eustachio Agricola, Francesco Maisano, Michele De Bonis
Published in
Journal of cardiovascular medicine (Hagerstown, Md.). Volume 27. Issue 10. Pages 798-803. Oct 01, 2026. Epub Oct 02, 2026.
Abstract
Contemporary data comparing double mechanical prostheses (DMP) vs. double biological prostheses (DBP) for concomitant aortic and mitral valve replacement are scarce, and the cumulative hemodynamic burden of simultaneous prosthesis-patient mismatch (PPM) at both positions has never been systematically assessed.
DMP recipients had lower in-hospital mortality (1.9% vs. 15.2%; P = 0.010) and superior 7-year survival (91.3% vs. 67.7%; P = 0.003), but significantly higher stroke rates (32.2% vs. 5.0%; P = 0.023). Combined PPM occurred in 64.6% of DBP vs. 14.8% of DMP (P < 0.001).
Concomitant double valve replacement confirmed its high-risk profile, with an overall in-hospital mortality of 10.5%. DMP demonstrated superior unadjusted survival (7-year: 91.3% vs. 67.7%; P = 0.003) but significantly higher stroke risk (32.2% vs. 5.0%; P = 0.023), without differences in major bleeding rates at follow-up (8.2% vs. 11.3%; P = 0.478), although baseline differences precluded definitive prosthesis-type recommendations after multivariable adjustment. Combined PPM is highly prevalent after DBP (64.6%) and emerged as a univariable mortality predictor (hazard ratio 1.97; P = 0.046); given the exploratory nature of the cPPM definition and its collinearity with prosthesis type, this should be regarded as hypothesis-generating and warrants validation in larger, ideally multicenter, cohorts.
PMID:
42886848
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.
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