Impact of Prosthesis–Patient Size on Functional Recovery After Aortic Valve Replacement

Abstract

Background-Prosthesis-patient size mismatch results when an implanted prosthetic aortic valve is of insufficient size for a patient's body surface area. The relation between prosthesis-patient size and functional capacity and adverse postoperative outcome is inconsistent. Our objectives were to examine the impact of valve replacement, continuous prosthesis-patient size, and other factors on functional recovery after aortic valve replacement (AVR) with the Duke Activity Status Index (DASI

Effect of prosthesis-patient mismatch on survival after aortic valve replacement using mechanical prostheses in patients with aortic stenosis

“…[4][5][6][7][8] In the present study, preoperative left ventricular function was relatively normal in all groups, especially in the PPM group. Moreover, the patients in the present study were relatively young.…”

“…Many studies have also shown that small functional prostheses with an EOAI < 0.85 cm 2 /m 2 , do not adversely affect outcomes in elderly AVR patients or in young patients with high cardiac output requirements. [4][5][6][7][8] In the present study, the risk of aortic root enlargement could not be evaluated due to the small number of subjects enrolled. However, aortic root enlargement reportedly increases the operative risk.…”

“…12 Therefore, when performing AVR in a relatively inactive, elderly patient with a short stature, if the patient's left ventricular function remains within normal limits, it is not necessary to replace the valve with a larger prosthesis to ensure an EOAI of ≥0.85 cm 2 /m 2 or even to perform additional aortic root enlargement. 2,[4][5][6][7][8][9] This is an important consideration, as the number of such patients is anticipated to increase. Prostheses, including high-performance mechanical valves, must be chosen carefully; to ensure an adequate EOAI, the EOA of these prosthetic valves should be larger, as those that have become available in recent years.…”

“…Although, many studies have shown that PPM is associated with increased operative mortality and postoperative impairment of patients' quality of life, 2,3 there are many studies that contradict these fi ndings. [4][5][6][7][8] Thus, there is considerable controversy regarding the effects of PPM on survival and postoperative cardiac function, including postoperative physical activity levels. The present study was designed to determine the effects of PPM based on the effective orifi ce area index (EOAI), survival, cardiac function, and physical activity levels following AVR.…”

Patient-prosthesis mismatch after aortic valve replacement in the elderly

“…Koch and his colleague stated that factors other than PPM infl uence functional quality of life early after AVR. 15 Howell and his colleagues, using multivariate analysis, showed that emergent surgery, LVEF (<30%), female sex, concomitant coronary artery bypass grafting, age (>80 years), and prolonged cross-clamping time were predictive of in-hospital mortality following AVR, whereas PPM was not. 16 Echocardiographic analysis also showed that PPM did not affect LVM regression rate after AVR in the midterm.…”