Patient-prosthesis mismatch in elderly patients undergoing aortic valve replacement: impact on quality of life and survival.
OBJECTIVE
Since the introduction of its theoretical basis, patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) has been the subject of much debate. The study aim was to compare, by a propensity score adjustment, the survival and quality of life in elderly patients with PPM, to those of a population without mismatch. The analysis was focused on elderly patients, as their high prevalence of calcific aortic stenosis may increase the probability to receive a small-sized aortic prosthesis, and consequently to experience postoperative PPM.


METHODS
A total of 163 patients aged > or = 75 years who underwent AVR was analyzed. The median logistic euroSCORE was 7.1%. PPM was considered to be present if the anticipated indexed effective orifice area (IEOA) was < or = 0.85 cm2/m2. The median follow up period was 37.4 months. The patients' quality of life was evaluated using the Short Form 12 (SF-12) Health Survey test.


RESULTS
PPM was present in 43% of the patients. In multivariable analysis, patients with PPM were more often female, more often operated on for aortic degenerative calcification, had a larger body surface area, and more often received a bioprosthesis than those without mismatch. The survival analysis did not highlight any significant difference between the two groups. According to a multivariable analysis, the SF-12 physical component score of PPM patients was significantly inferior to that in patients without mismatch (p = 0.001).


CONCLUSIONS
The study results suggest that moderate PPM does not have a negative impact on mid-term mortality in elderly patients after AVR. However, PPM was associated with a reduced quality of life in this elderly population.
Urso
Stefano
S
Department of Cardiac Surgery, Clínica Capio, Albacete, Spain. stefano_urso@inwind.it
Sadaba
Rafael
R
Vives
Manuel
M
Trujillo
John
J
Beltrame
Sergio
S
Soriano
Beatriz
B
Piqueras
Lucia
L
Aldamiz-Echevarria
Gonzalo
G
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000523:psychology* / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology