[Impact of prosthesis-patient mismatch on the quality of life of elderly patients after aortic valve replacement].
OBJECTIVE
To evaluate the long-term changes in the quality of life (QOL) scores in elderly patients after aortic valve replacement, and assess the impact of prosthesis-patient mismatch on the QQL of the patients.


METHODS
A prospective cohort study was conducted involving 100 consecutive elderly patients above 70 years of age, who underwent isolated aortic valve or simultaneous aortic valve-coronary artery bypass graft (CABG) procedures between August 10, 1995 and August 19, 1998. Patient-prosthesis mismatch (PPM) was defined as a prosthetic aortic valve EOAI of 0.85 cm2/m2 or less. The clinical follow-up examinations were carried out at 4 weeks and 6 months after the operation, and then annually afterwards. Cumulative and comparative analyses of the long-term outcomes and gradient pressure of the prosthetic valve were performed. The QOL of the patients was evaluated using the Short Form 36-Item Health Survey (SF-36) questionnaire.


RESULTS
The mean age of the patients at prosthesis implantation was 74.7-/+5.7 years (range 70-87 years). The patients were followed up for a mean of 7.3-/+4.5 years. The thirty-day mortality was 6.3% in the mismatch group, and 3.3% in the matching group. The freedom from death showed no significant difference between the two groups at the first, third and fifth years after the prosthetic implantation, but differed significantly at the seventh year. The echocardiographic data showed significant differences in the mean gradient pressure between the two groups at the first and fifth years postoperatively. At most of the time points for follow-up examination, the general health and energy/vitality of the patients all improved from the preoperative levels, but no significant improvement was found at the third, fifth, and seventh years in the role emotional, social role, or general mental health; at the first postoperative year, however, the role emotional, social role, and particularly mental health, presented with significant improvements in comparison with the preoperative levels. No obvious difference in the QOL was noted between the two groups at the time points of observation.


CONCLUSIONS
Aortic vale replacement improves the QOL of the elderly patients, but the degree of improvements do not seem to be influenced by PPM. The interpretation of the impact of PPM on the clinic outcome of the patients still remains controversial.
Qian
Xi-ming
XM
Institute of Clinical Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangzhou 510515, China. xmqian@163.com
Zhong
Shi-zhen
SZ
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000009:adverse effects*; D011788:Quality of Life; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology