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 S. Lawton, Nader Moazami, John E. Codd, Traves D. Crabtree, Hendrick B. Barner, Ralph J. Damiano

Research output: Contribution to journalArticlepeer-review

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

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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