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Does patient–prosthesis mismatch after aortic valve replacement affect survival and quality of life in elderly patients?

Sportelli, Elena; Regesta, Tommaso; Salsano, Antonio; Ghione, Paola; Brega, Carlotta; Bezante, Gian Paolo; Passerone, Giancarlo; Santini, Francesco

Journal of Cardiovascular Medicine: February 2016 - Volume 17 - Issue 2 - p 137–143
doi: 10.2459/JCM.0000000000000292
Cardiac surgery

Background To evaluate the impact of patient–prosthesis mismatch (PPM) on survival, functional status, and quality of life (QoL) after aortic valve replacement (AVR) with small prosthesis size in elderly patients.

Methods Between January 2005 and December 2013, 152 patients with pure aortic stenosis, aged at least 75 years, underwent AVR, with a 19 or 21 mm prosthetic heart valve. PPM was defined as an indexed effective orifice area less than 0.85 cm2/m2. Median age was 82 years (range 75–93 years). Mean follow-up was 56 months (range 1–82 months) and was 98% complete. Late survival rate, New York Heart Association functional class, and QoL (RAND SF-36) were assessed.

Results Overall, PPM was found in 78 patients (53.8%). Among them, 42 patients (29%) had an indexed effective orifice area less than 0.75 cm2/m2 and 17 less than 0.65 cm2/m2 (11.7%). Overall survival at 5 years was 78 ± 4.5% and was not influenced by PPM (P = NS). The mean New York Heart Association class for long-term survivors with PPM improved from 3.0 to 1.7 (P < 0.001). QoL (physical functioning 45.18 ± 11.35, energy/fatigue 49.36 ± 8.64, emotional well being 58.84 ± 15.44, social functioning 61.29 ± 6.15) was similar to that of no-PPM patients (P = NS).

Conclusion PPM after AVR does not affect survival, functional status, and QoL in patients aged at least 75 years. Surgical procedures, often time-consuming, contemplated to prevent PPM, may therefore be not justified in this patient subgroup.

aDivision of Cardiac Surgery

bDivision of Cardiology, IRCCS San Martino-IST, University of Genova Medical School, Genova, Italy

Correspondence to Elena Sportelli, MD, Division of Cardiac Surgery, University of Genova Medical School, Largo Rosanna Benzi 10, 16132 Genova, ItalyTel: +39 010 5553872; fax: +39 010 5556776; e-mail:

Received 21 December, 2014

Revised 27 February, 2015

Accepted 7 April, 2015

© 2016 Italian Federation of Cardiology. All rights reserved.