Aortic valve replacement with 19-mm bileaflet prostheses in the elderly: left ventricular mass regression and quality of life.
OBJECTIVE
The study aim was to evaluate left ventricular mass (LVM) regression, survival and quality of life in elderly patients after aortic valve replacement (AVR) with small-sized bileaflet prostheses.


METHODS
Between September 1988 and September 2005, a total of 147 patients aged > 70 years underwent AVR with 19-mm bileaflet prostheses for aortic stenosis. In order to evaluate the impact of prosthesis-patient mismatch (PPM) on long-term outcome, survivors were allocated to two groups according to the effective orifice area index (EOAI): group A, with EOAI < 0.85 cm2/m2, and group B with EOAI > or = 0.85 cm2/m2. Hospital survivors were interviewed using the SF-36 questionnaire, and the scores compared with those of age- and gender-matched members of the general Italian population.


RESULTS
The mean patient age was 74.5 +/- 3.5 years, body surface area (BSA) 1.68 +/- 0.15 m2, and EOAI 0.73 +/- 0.2 cm2/m2. Hospital mortality was 8.8% (n = 13). Actuarial survival was 87.1 +/- 0.028% at one year, 81.3 +/- 0.035% at five years, and 77.2 +/- 0.044% at eight years. Eight-year survival was 74.0 +/- 0.062% in group A and 82.5 +/- 0.064% in group B (p = 0.29). Echocardiographic follow up showed a significant regression of LVM. Scores obtained in the SF-36 test were similar in the two groups, and significantly higher than those of the general Italian population matched for age and gender (p < 0.001 in all domains).


CONCLUSIONS
The implantation of 19-mm bileaflet mechanical prostheses in the elderly allowed LVM regression and a good perceived quality of life. PPM did not influence the long-term survival of these patients.
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy. marianovicchio@libero.it
Mariano
M
Vicchio
Luca Salvatore
LS
De Santo
Alessandro
A
Della Corte
Marisa
M
De Feo
Raffaella
R
Provenzano
Maurizio
M
Miraglia
Michelangelo
M
Scardone
Maurizio
M
Cotrufo
D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D006305:Health Status Indicators; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000517:prevention & control; D008297:Male; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011788:Quality of Life