Does patient-prosthesis mismatch after aortic valve replacement affect survival and quality of life in elderly...

Area of Science:

• Cardiovascular Surgery
• Geriatric Cardiology
• Prosthetic Heart Valves

Background:

• Patient-prosthesis mismatch (PPM) is a concern after aortic valve replacement (AVR), particularly with small prosthesis sizes in elderly patients.
• The impact of PPM on long-term outcomes like survival, functional capacity, and quality of life (QoL) in this specific population requires thorough evaluation.

Purpose of the Study:

• To assess the influence of PPM on survival, functional status, and QoL in patients aged 75 years and older following AVR with small prosthetic valves.
• To determine if aggressive surgical strategies to avoid PPM are warranted in this elderly patient subgroup.

Main Methods:

• A cohort of 152 patients (≥75 years) with pure aortic stenosis underwent AVR using 19 or 21 mm prosthetic valves between 2005 and 2013.
• PPM was defined by indexed effective orifice area (<0.85 cm²/m). Outcomes including survival, New York Heart Association (NYHA) class, and QoL (RAND SF-36) were analyzed over a median follow-up of 56 months.

Main Results:

• PPM was present in 53.8% of patients. Overall 5-year survival was 78% and not significantly influenced by PPM.
• Despite PPM, NYHA functional class improved significantly in survivors (mean 3.0 to 1.7).
• Quality of life scores (physical functioning, energy/fatigue, emotional well-being, social functioning) were comparable between patients with and without PPM.

Conclusions:

• Patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) does not adversely affect survival, functional status, or quality of life in elderly patients (≥75 years).
• Complex surgical procedures aimed at preventing PPM may not be necessary or justified in this patient group.