Patient-Prosthesis Mismatch in Elderly Patients Undergoing Aortic Valve Replacement: Impact on Quality of Life and Survival

Background and aim of the study: Since the introduction of its theoretical basis, patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) has been the subject of much debate. The study aim was to compare, by a propensity score adjustment, the survival and quality of life in elderly patients with PPM, to those of a population without mismatch. The analysis was focused on elderly patients, as their high prevalence of calcific aortic stenosis may increase the probability to receive a small-sized aortic prosthesis, and consequently to experience postoperative PPM. Methods: A total of 163 patients aged 75 years who underwent AVR was analyzed. The median logistic euroSCORE was 7.1%. PPM was considered to be present if the anticipated indexed effective orifice area (IEOA) was <= 0.85 cm(2)/m(2). The median follow up period was 37.4 months. The patients' quality of life was evaluated using the Short Form 12 (SF-12) Health Survey test. Results: PPM was present in 43% of the patients. In multivariable analysis, patients with PPM were more often female, more often operated on for aortic degenerative calcification, had a larger body surface area, and more often received a bioprosthesis than those without mismatch. The survival analysis did not highlight any significant difference between the two groups. According to a multivariable analysis, the SF12 physical component score of PPM patients was significantly inferior to that in patients without mismatch (p = 0.001). Conclusion: The study results suggest that moderate PPM does not have a negative impact on mid-term mortality in elderly patients after AVR. However, PPM was associated with a reduced quality of life in this elderly population.