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

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 21mm 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 0.75cm2/m217 less than 0.65 cm2/m2 (11.7%). Overall survival at 5 years was 78±4.5% and was not influenced by PPM (PUNS). 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.