Prosthesis-Patient Mismatch is Irrelevant for Patients Greater than 70 Years of Age Undergoing Bioprosthetic Aortic Valve Replacement
Marc R. Moon, Jennifer S. Lawton, Nabil A. Munfakh, Nader Moazami, Kristen A. Aubuchon, Kelly A. Baker, Michael K. Pasque, Ralph J. Damiano; Cardiothoracic Surgery, Washington University School of Medicine, Saint Louis, MO
Comment on this Abstract
Objective: The purpose of this investigation was to examine the impact of prosthesis-patient mismatch (PPM) following bioprosthetic AVR on long-term survival in patients greater than 70 years of age compared to those less than 70 years of age.
Methods: Between 1992 and 2007, 1,399 patients underwent bioprosthetic AVR, including 518 patients ≤ 70 years of age and 881 patients > 70 years of age. PPM was defined as severe (prosthetic effective orifice area/body surface area <0.65 cm2/m2), moderate (0.65 to 0.85 cm2/m2), or absent (>0.85 cm2/m2). For patients ≤70 yo, PPM was severe in 62 (12%), moderate in 251 (48%), and absent in 205 (40%). For patients >70 yo, PPM was severe in 109 (12%), moderate in 451 (51%), and absent in 321 (37%).
Results: For patients ≤70 yo, PPM was associated with impaired long-term survival (Figure top). Survival at 5 and 10 years was 61±7% and 28±12% for severe PPM (mean survival 77 months), 65±3% and 40±5% for moderate PPM (92 months), and 73±5% and 46±9% for no PPM (98 months) (p=0.015). In contrast, for patients > 70 yo, PPM did not impact long-term survival (Figure bottom). Survival at 5 and 10 years was 62±5% and 42±6% for severe PPM (mean survival 96 months), 62±2% and 30±5% for moderate PPM (87 months), and 53±4% and 29±5% for absent PPM (77 months) (p=0.25).
Conclusion: Thus, following bioprosthetic AVR, PPM had a negative impact on late survival for patients younger than 70 years of age, but for patients greater than 70 years of age, PPM did not influence late survival.
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