Prosthesis-patient mismatch in the elderly: survival, ventricular mass regression, and quality of life.
BACKGROUND
Evaluation of the impact of prosthesis-patient mismatch (PPM) on long-term outcome and quality of life (QOL) in elderly patients who underwent implantation of small size bileaflet prostheses for aortic stenosis.


METHODS
Between September 1988 and September 2006, 377 patients aged greater than 70 years underwent aortic valve replacement with a small size bileaflet prosthesis (17, 19, and 21 mm) in one Institution. The study population's survivors (345 patients) were divided into three groups according to the indexed effective orifice area (EOAI): Group A included patients with EOAI less than 0.60 cm(2)/m(2); group B included patients with EOAI ranging between 0.61 and 0.84 cm(2)/m(2); and group C included patients with EOAI 0.85 cm(2)/m(2) or greater. Cumulative and comparative analyses of long-term outcomes and of left ventricular mass regression were performed. The QOL was evaluated with the 36-Item Short Form Health Survey (SF-36) questionnaire.


RESULTS
Overall hospital mortality was 8.5% (32 patients). Group A included 33 patients (9.6%), group B 175 (50.7%), and group C 137 (39.7%). Actuarial survival was 88.8% +/- 0.016 at 1 year, 82.1% +/- 0.022 at 5 years, and 76.7% +/- 0.032 at 10 years. No difference emerged among the three groups. A significant reduction in left ventricular mass was observed in all groups and in all patient subsets of prosthetic size. The scores obtained in the SF-36 test were similar in the three groups and significantly higher than those of the general population (p < 0.001 in all domains).


CONCLUSIONS
Incidence of severe PPM is low after aortic valve replacement. Presence of severe or moderate PPM, did not influence long-term outcome, left ventricular mass regression and QOL in a population of septuagenarians.
Vicchio
Mariano
M
Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
Della Corte
Alessandro
A
De Santo
Luca Salvatore
LS
De Feo
Marisa
M
Caianiello
Giuseppe
G
Scardone
Michelangelo
M
Cotrufo
Maurizio
M
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001705:Bioprosthesis; D001830:Body Surface Area; D016022:Case-Control Studies; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D015577:Geriatric Assessment; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D009929:Organ Size; D011336:Probability; D011379:Prognosis; D011474:Prosthesis Design; D017755:Prosthesis Fitting; D011788:Quality of Life; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome