[Influence of patient-prosthesis mismatch in the octogenarian undergoing surgery for aortic valve replacement due to severe stenosis]

Introduction and objectives: The clinical impact of patient-prosthesis mismatch on the outcome in octogenarians who undergo surgery for aortic valve replacement due to severe stenosis is unknown. Our objective was to quantify the frequency of some degree of patient-prosthesis mismatch and its impact on mortality and life quality.

Methods: We analyzed all the octogenarian patients who underwent surgery for aortic valve replacement due to severe stenosis in our center from February 2004 to April 2009. Patient-prosthesis mismatch was considered to exist when the indexed effective orifice area was ≤ 0.85 cm²/m². The influence of patient-prosthesis mismatch on in-hospital mortality, medium-term survival, and New York Heart Association functional class was studied using an analysis adjusted for propensity score.

Results: Of 149 patients studied, 61.7% had some degree of patient-prosthesis mismatch (mean follow-up was 32.71 ± 14.42 months). After adjusting for propensity score, there were no differences in in-hospital mortality (odds ratio=0.75; 95% confidence interval, 0.15-3.58; P=.72), medium-term survival (hazard ratio=1; 95% confidence interval, 0.36-2.78; P=.99) or functional class during follow-up (odds ratio=1.46; 95% confidence interval, 0.073-29.24; P=.8).

Conclusions: Although moderate patient-prosthesis mismatch is a very common finding in octogenarian patients who undergo aortic valve replacement, its influence on mortality and quality of life does not seem to be relevant. The biological profile of elderly patients with lower metabolic requirements and limited physical activity could justify the results obtained.