Moderate Prosthesis-Patient Mismatch May Be Negligible in Elderly Patients Undergoing Conventional Aortic Valve Replacement for Aortic Stenosis

Abstract

SummaryTogether with aging of the Japanese population, aortic valve replacement (AVR) for aortic stenosis (AS) is now becoming more and more common in the elderly. When the aortic annulus is too small to allow an adequate sized prosthetic valve, aortic root enlargement is required to avoid prosthesis-patient mismatch (PPM). However, age-related comorbidities including aortic root calcifi cation bring signifi cant risk in performing aortic root enlargement. In the present study, 40 patients aged 75 years or more who underwent AVR for AS were reviewed to determine whether moderate PPM has a negative impact on the long-term results. Operative mortality occurred in 2 patients (5%) and moderate PPM occurred in 8 patients. There was no signifi cant difference in survival between cases with and without PPM (P = 0.87). Both aortic pressure gradient (PG) and left ventricular mass index (LVMI) measured by echocardiography were significantly decreased in patients with and without PPM. Reduction of PG was signifi cantly greater in patients with PPM than without PPM (P = 0.02). Reduction of LVMI was not different between the groups (P = 0.58). Moderate PPM did not negatively infl uence survival or reduction of PG or LVMI in patients aged 75 years or older who underwent AVR for AS. (Int Heart J 2013; 54: 11-14)

Minimally Invasive Aortic Valve Replacement Following Root Enlargement on too Narrow Annulus to Perform Transcatheter Aortic Valve Implantation

“…4) In our hospital, small annulus requiring root enlargement has traditionally been a contraindication of MIAVR. 2) Kitamura, et al reported that moderate prosthesis-patient mismatch did not have negative impact on survival or reduction of left ventricular mass index in elderly patients; 5) however, aortic valve replacement using a small mechanical valve would deteriorate quality of life in elderly patients. Based on our experience of performing more than 200 cases of MIAVR, we decided to perform aortic valve replacement with a bioprosthesis following root enlargement through a right mini-thoracotomy for the patient.…”

The effect of prosthesis-patient mismatchon early myocardial remodeling after aortic valve replacement

“…Аналогичная связь прослеживается между РРМ и развитием послеоперационной сердечной недостаточности, отдаленной летальностью и замедлением регрессии гипер-трофии ЛЖ [3,18]. При развитии РРМ происходит уменьшение сердечного выброса в послеоперационном периоде, оно наиболее выражено в группе тяжелого несоответствия [8,19]. В нашей работе у больных обеих групп исходно была сохранная насосная функция сердца, она незначительно изменялась в раннем послеоперационном периоде в обеих группах (см.…”

Replacement of the St Jude Medical Regent Valve in the Aortic Position with a Continuous Suture Technique in the Small Aortic Root

“…The average age of our study group was relatively young with only two patients over the age of 65. Several studies have demonstrated that the presence of severe or moderate PPM did not influence long‐term outcome, left ventricular mass regression, and quality of life in elderly patients undergoing AVR . Degenerative aortic valve in the elderly often results in aortic stenosis with more calcified cusps and annulus.…”

“…Several studies have demonstrated that the presence of severe or moderate PPM did not influence long-term outcome, left ventricular mass regression, and quality of life in elderly patients undergoing AVR. 29,30 Degenerative aortic valve in the elderly often results in aortic stenosis with more calcified cusps and annulus. A continuous suture in a severely calcified ring easily leads to suture tearing and increases the incidence of paravalvular leakage.…”