Aortic Valve Replacement with Smaller Prostheses in Elderly Patients: Does Patient Prosthetic Mismatch Affect Outcomes?

Abstract

PPM does not affect survival in this series of elderly patients. We believe that more aggressive surgical procedures are not justified in these patients.

Impact of mild patient prosthesis mismatch on quality of life in patients with preserved ejection fraction after isolated aortic valve replacement for aortic stenosis

“…This means that pressure unloading is significant enough to decrease symptoms, even if some degree of hemodynamic obstruction is still present. These findings are similar like those in previous studies with elderly patients (5,7,(12)(13)(15)(16), even though elderly patients have less demanding life style.…”

“…However, some smaller studies have found difference in functional status and the quality of life in elderly, 70-80 years old patient population (5,7,(12)(13)(14)(15)(16). However, in these studies, patients were dispersive concerning the type of the procedure (isolated AVR, or AVR+CABG) and systolic LV function prior operation, two factors interfering with mortality rate and physical functioning.…”

“…However, the impact of patient prosthesis mismatch on the outcomes remains unresolved. In some studies, PPM did impact long term survival and cardiac related deaths (9-11) whereas in other there was no significant difference comparing to no PPM patients (8,(11)(12). Studies are more uniform regarding functional capacity, with no difference comparing to no PPM patients, especially in the elderly (5,7,(12)(13)(14)(15)(16).…”

Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies

“…Of the 93 studies, 51 proved at overall low risk of bias. 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 Twenty one of the remaining 42 proved at overall moderate risk of bias 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 and 21 at overall high risk of bias. 90 91 92 93 94 95 …”

Desproporción prótesis-paciente luego de reemplazo de válvula aórtica y seguimiento a 6 años

“…Sin embargo, el impacto del desajuste prótesis-paciente sigue sin resolverse y los resultados controvertidos. En algunos estudios, DPP tuvo un impacto en la sobrevida a largo plazo y muertes cardiovasculares 12,13 , mientras que en otros no hubo diferencia significativa en comparación con aquellos que no presentaban DPP 14,15 . Los estudios son más uniformes con respecto a la capacidad funcional, aunque sin encontrar diferencias en los pacientes de mayor edad 16,18 .…”