Prosthesis-patient mismatch after aortic valve replacement: Impact of age and body size on late survival

Marc R. Moon, Michael K. Pasque, Nabil A. Munfakh, Spencer J. Melby, Jennifer Lawton, Nader Moazami, John E. Codd, Traves D. Crabtree, Hendrick B. Barner, Ralph J. Damiano

Research output: Contribution to journalArticle

Abstract

Background. The purpose of this study was to identify patient subgroups in which prosthesis-patient mismatch most influenced late survival. Methods. Over a 12-year period, 1,400 consecutive patients underwent bioprosthetic (933 patients) or mechanical (467) aortic valve replacement. Prosthesis-patient mismatch was defined as prosthetic effective orifice area/body surface area less than 0.75 cm2/m2 and was present with 11% mechanical and 51% bioprosthetic valves. Results. With bioprosthetic valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 68% ± 7% mismatch versus 75% ± 7% no mismatch, p< 0.02) but not older patients (p= 0.47). Similarly, with mechanical valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 62% ± 11% versus 79% ± 4%, p < 0.005) but not older patients (p = 0.26). For small patients (body surface area less than 1.7 m2), prosthesis-patient mismatch did not impact survival with bioprosthetic (p = 0.32) or mechanical (p= 0.71) valves. For average-size patients (body surface area 1.7 to 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with both bioprosthetic (p < 0.05) and mechanical (p< 0.005) valves. For large patients (body surface area greater than 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with mechanical (p< 0.04) but not bioprosthetic (p= 0.40) valves. Conclusions. Prosthesis-patient mismatch had a negative impact on survival for young patients, but its impact on older patients was minimal. In addition, although prosthesis-patient mismatch was not important in small patients, prosthesis-patient mismatch negatively impacted survival for average-size patients and for large patients with mechanical valves.

Original languageEnglish (US)
Pages (from-to)481-489
Number of pages9
JournalAnnals of Thoracic Surgery
Volume81
Issue number2
DOIs
StatePublished - Feb 2006
Externally publishedYes

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Body Size
Aortic Valve
Prostheses and Implants
Survival
Body Surface Area

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Prosthesis-patient mismatch after aortic valve replacement : Impact of age and body size on late survival. / Moon, Marc R.; Pasque, Michael K.; Munfakh, Nabil A.; Melby, Spencer J.; Lawton, Jennifer; Moazami, Nader; Codd, John E.; Crabtree, Traves D.; Barner, Hendrick B.; Damiano, Ralph J.

In: Annals of Thoracic Surgery, Vol. 81, No. 2, 02.2006, p. 481-489.

Research output: Contribution to journalArticle

Moon, MR, Pasque, MK, Munfakh, NA, Melby, SJ, Lawton, J, Moazami, N, Codd, JE, Crabtree, TD, Barner, HB & Damiano, RJ 2006, 'Prosthesis-patient mismatch after aortic valve replacement: Impact of age and body size on late survival', Annals of Thoracic Surgery, vol. 81, no. 2, pp. 481-489. https://doi.org/10.1016/j.athoracsur.2005.07.084
Moon, Marc R. ; Pasque, Michael K. ; Munfakh, Nabil A. ; Melby, Spencer J. ; Lawton, Jennifer ; Moazami, Nader ; Codd, John E. ; Crabtree, Traves D. ; Barner, Hendrick B. ; Damiano, Ralph J. / Prosthesis-patient mismatch after aortic valve replacement : Impact of age and body size on late survival. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 2. pp. 481-489.
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abstract = "Background. The purpose of this study was to identify patient subgroups in which prosthesis-patient mismatch most influenced late survival. Methods. Over a 12-year period, 1,400 consecutive patients underwent bioprosthetic (933 patients) or mechanical (467) aortic valve replacement. Prosthesis-patient mismatch was defined as prosthetic effective orifice area/body surface area less than 0.75 cm2/m2 and was present with 11{\%} mechanical and 51{\%} bioprosthetic valves. Results. With bioprosthetic valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 68{\%} ± 7{\%} mismatch versus 75{\%} ± 7{\%} no mismatch, p< 0.02) but not older patients (p= 0.47). Similarly, with mechanical valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 62{\%} ± 11{\%} versus 79{\%} ± 4{\%}, p < 0.005) but not older patients (p = 0.26). For small patients (body surface area less than 1.7 m2), prosthesis-patient mismatch did not impact survival with bioprosthetic (p = 0.32) or mechanical (p= 0.71) valves. For average-size patients (body surface area 1.7 to 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with both bioprosthetic (p < 0.05) and mechanical (p< 0.005) valves. For large patients (body surface area greater than 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with mechanical (p< 0.04) but not bioprosthetic (p= 0.40) valves. Conclusions. Prosthesis-patient mismatch had a negative impact on survival for young patients, but its impact on older patients was minimal. In addition, although prosthesis-patient mismatch was not important in small patients, prosthesis-patient mismatch negatively impacted survival for average-size patients and for large patients with mechanical valves.",
author = "Moon, {Marc R.} and Pasque, {Michael K.} and Munfakh, {Nabil A.} and Melby, {Spencer J.} and Jennifer Lawton and Nader Moazami and Codd, {John E.} and Crabtree, {Traves D.} and Barner, {Hendrick B.} and Damiano, {Ralph J.}",
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T1 - Prosthesis-patient mismatch after aortic valve replacement

T2 - Impact of age and body size on late survival

AU - Moon, Marc R.

AU - Pasque, Michael K.

AU - Munfakh, Nabil A.

AU - Melby, Spencer J.

AU - Lawton, Jennifer

AU - Moazami, Nader

AU - Codd, John E.

AU - Crabtree, Traves D.

AU - Barner, Hendrick B.

AU - Damiano, Ralph J.

PY - 2006/2

Y1 - 2006/2

N2 - Background. The purpose of this study was to identify patient subgroups in which prosthesis-patient mismatch most influenced late survival. Methods. Over a 12-year period, 1,400 consecutive patients underwent bioprosthetic (933 patients) or mechanical (467) aortic valve replacement. Prosthesis-patient mismatch was defined as prosthetic effective orifice area/body surface area less than 0.75 cm2/m2 and was present with 11% mechanical and 51% bioprosthetic valves. Results. With bioprosthetic valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 68% ± 7% mismatch versus 75% ± 7% no mismatch, p< 0.02) but not older patients (p= 0.47). Similarly, with mechanical valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 62% ± 11% versus 79% ± 4%, p < 0.005) but not older patients (p = 0.26). For small patients (body surface area less than 1.7 m2), prosthesis-patient mismatch did not impact survival with bioprosthetic (p = 0.32) or mechanical (p= 0.71) valves. For average-size patients (body surface area 1.7 to 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with both bioprosthetic (p < 0.05) and mechanical (p< 0.005) valves. For large patients (body surface area greater than 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with mechanical (p< 0.04) but not bioprosthetic (p= 0.40) valves. Conclusions. Prosthesis-patient mismatch had a negative impact on survival for young patients, but its impact on older patients was minimal. In addition, although prosthesis-patient mismatch was not important in small patients, prosthesis-patient mismatch negatively impacted survival for average-size patients and for large patients with mechanical valves.

AB - Background. The purpose of this study was to identify patient subgroups in which prosthesis-patient mismatch most influenced late survival. Methods. Over a 12-year period, 1,400 consecutive patients underwent bioprosthetic (933 patients) or mechanical (467) aortic valve replacement. Prosthesis-patient mismatch was defined as prosthetic effective orifice area/body surface area less than 0.75 cm2/m2 and was present with 11% mechanical and 51% bioprosthetic valves. Results. With bioprosthetic valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 68% ± 7% mismatch versus 75% ± 7% no mismatch, p< 0.02) but not older patients (p= 0.47). Similarly, with mechanical valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 62% ± 11% versus 79% ± 4%, p < 0.005) but not older patients (p = 0.26). For small patients (body surface area less than 1.7 m2), prosthesis-patient mismatch did not impact survival with bioprosthetic (p = 0.32) or mechanical (p= 0.71) valves. For average-size patients (body surface area 1.7 to 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with both bioprosthetic (p < 0.05) and mechanical (p< 0.005) valves. For large patients (body surface area greater than 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with mechanical (p< 0.04) but not bioprosthetic (p= 0.40) valves. Conclusions. Prosthesis-patient mismatch had a negative impact on survival for young patients, but its impact on older patients was minimal. In addition, although prosthesis-patient mismatch was not important in small patients, prosthesis-patient mismatch negatively impacted survival for average-size patients and for large patients with mechanical valves.

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