title: Stentless bioprostheses in small aortic roots: impact of patient-prosthesis mismatch on survival and quality of life.
abstract: OBJECTIVE
  Although stentless bioprostheses offer hemodynamic advantages, prosthetic valves of smaller size may provide less reduction of left ventricular hypertrophy and, therefore, affect survival and quality of life.
  
  
  METHODS
  A total of 303 patients (mean age 75 +/- 7 years) who underwent aortic valve replacement with the stentless Freestyle bioprostheses were followed up. The impact of projected indexed effective orifice area (IEOA) on survival and quality of life (QoL) was determined multivariately by Cox regression and logistic regression analysis.
  
  
  RESULTS
  Independent predictors of survival time were diabetes mellitus (p < 0.001), atrial fibrillation (p = 0.004), male gender (p = 0.015), peripheral vascular disease (p = 0.039), and patient-prosthesis mismatch (PPM, defined as projected IEOA < 0.75 cm2/m2) in patients with aortic regurgitation (p = 0.017). A history of congestive heart failure (p = 0.016), small body mass index (p = 0.01), age > 75 years (p = 0.002) and small projected IEOA (p = 0.016) were identified as predictors of impaired QoL.
  
  
  CONCLUSIONS
  PPM and small projected IEOA were identified as independent risk factors for impaired mid-term survival and QoL. As the occurrence of PPM was rare in total root replacements, and the implantation procedure did not increase the operative risk in the present patient population, the recommendation is made to consider this implantation technique if a small projected IEOA is expected.
authors.affiliation: Herzzentrum Lahr/Baden, Hohbergweg 2, Lahr, Germany. juergen.ennker@heart-lahr.com
authors.forename: Jürgen
authors.initials: J
authors.lastname: Ennker
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rosendahl
authors.forename: Alexander
authors.initials: A
authors.lastname: Albert
authors.forename: Ercan
authors.initials: E
authors.lastname: Dumlu
authors.forename: Ina Carolin
authors.initials: IC
authors.lastname: Ennker
authors.forename: Ines
authors.initials: I
authors.lastname: Florath
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications; D001705:Bioprosthesis; D048909:Diabetes Complications; D005221:Fatigue / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality* / Q000523:psychology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D010147:Pain Measurement; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011788:Quality of Life; D012307:Risk Factors; D012737:Sex Factors; D012890:Sleep; D012934:Social Isolation