title: Moderate prosthesis-patient mismatch may be negligible in elderly patients undergoing conventional aortic valve replacement for aortic stenosis.
abstract: Together with aging of the Japanese population, aortic valve replacement (AVR) for aortic stenosis (AS) is now becoming more and more common in the elderly. When the aortic annulus is too small to allow an adequate sized prosthetic valve, aortic root enlargement is required to avoid prosthesis-patient mismatch (PPM). However, age-related comorbidities including aortic root calcification bring significant risk in performing aortic root enlargement. In the present study, 40 patients aged 75 years or more who underwent AVR for AS were reviewed to determine whether moderate PPM has a negative impact on the long-term results. Operative mortality occurred in 2 patients (5%) and moderate PPM occurred in 8 patients. There was no significant difference in survival between cases with and without PPM (P = 0.87). Both aortic pressure gradient (PG) and left ventricular mass index (LVMI) measured by echocardiography were signifi cantly decreased in patients with and without PPM. Reduction of PG was significantly greater in patients with PPM than without PPM (P = 0.02). Reduction of LVMI was not different between the groups (P = 0.58). Moderate PPM did not negatively influence survival or reduction of PG or LVMI in patients aged 75 years or older who underwent AVR for AS.
authors: Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors: Tadashi
authors: T
authors: Kitamura
authors: Shinzo
authors: S
authors: Torii
authors: Naoji
authors: N
authors: Hanayama
authors: Norihiko
authors: N
authors: Oka
authors: Takahiro
authors: T
authors: Tomoyasu
authors: Yusuke
authors: Y
authors: Irisawa
authors: Miyuki
authors: M
authors: Shibata
authors: Hidenori
authors: H
authors: Hayashi
authors: Takamichi
authors: T
authors: Inoue
authors: Kagami
authors: K
authors: Miyaji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062186:Arterial Pressure; D002114:Calcinosis / Q000473:pathology*; D004452:Echocardiography; D019544:Equipment Failure Analysis; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D017755:Prosthesis Fitting / Q000009:adverse effects / Q000379:methods; D020379:Risk Adjustment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors