Patient-prosthesis mismatch after aortic valve replacement in the elderly.
OBJECTIVE
The aim of this study was to analyze the effect of patient-prosthesis mismatch (PPM) on survival and left ventricular mass regression in elderly patients after aortic valve replacement (AVR).


METHODS
Data on patients >65 years old who underwent isolated AVR from 1990 and 2007 were analyzed retrospectively. A bioprosthesis was used in 42 cases and a mechanical valve in 59. The mean follow-up period was 3.1 years (0.1-14.2 years). The indexed effective orifice area (i-EOA) was determined from echocardiographic data in clinical reports in the literature and indexed to body surface area (cm2/m2). Mild PPM was defined as an i-EOA between 0.65 and 0.85. We also evaluated the New York Heart Association (NYHA) classification and the left ventricular mass (LVM) index.


RESULTS
A total of 34 patients (33.6%) had PPM. No patient had an i-EOA <0.65. Freedom from valve-related death was 86.3% +/- 6.7% in the PPM-negative group and 85.7% +/- 7.9% in the PPM-positive group at 5 years after AVR. The mean LVM index (g/m2) decreased significantly (P < 0.01), from 239.2 to 167.4 in the PPM-negative group and from 229.1 to 154.4 in the PPM-positive group, respectively. NYHA functional status was excellent at late follow-up in both groups.


CONCLUSIONS
Mild PPM occurred in a large proportion of elderly patients undergoing AVR but did not affect midterm survival or LV mass regression.
Ryomoto
Masaaki
M
Department of Cardiovascular Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan.
Mitsuno
Masataka
M
Yamamura
Mitsuhiro
M
Tanaka
Hiroe
H
Kobayashi
Yasuhiko
Y
Fukui
Shinya
S
Tsujiya
Noriko
N
Kajiyama
Tetsuya
T
Miyamoto
Yuji
Y
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography