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J Thorac Cardiovasc Surg 2009;137:278-283
© 2009 The American Association for Thoracic Surgery

Point/Counterpoint

POINT: Prosthesis–patient mismatch does not affect survival for patients greater than 70 years of age undergoing bioprosthetic aortic valve replacement

Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo

Received for publication June 3, 2008; revisions received September 16, 2008; accepted for publication September 30, 2008.

^_* Address for reprints: Marc R. Moon, MD, Division of Cardiothoracic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Box 8234, St Louis, MO 63110-1013. (Email: moonm{at}wustl.edu).

Objective: The purpose of this investigation was to examine the impact of prosthesis–patient mismatch after bioprosthetic aortic valve replacement on long-term survival in patients greater than 70 years of age compared with those less than or equal to 70 years of age.

Methods: Between 1992 and 2007, 1399 patients underwent bioprosthetic aortic valve replacement, including 881 (63%) patients older than 70 years of age. Prosthesis–patient mismatch was defined as severe (prosthetic effective orifice area/body surface area < 0.65 cm²/m²), moderate (0.65–0.85 cm²/m²), or absent (>0.85 cm²/m²). For patients less than or equal to 70 years of age, mismatch was severe in 62 (12%), moderate in 251 (48%), and absent in 205 (40%). For patients greater than 70 years of age, mismatch was severe in 109 (12%), moderate in 451 (51%), and absent in 321 (37%). There was no difference in the distribution of prosthesis–patient mismatch between age groups (P = .50).

Results: For patients less than or equal to 70 years, prosthesis–patient mismatch was associated with impaired long-term survival (P = .02). Survival at 5 and 10 years was 61% ± 7% and 28% ± 12% for severe mismatch, 65% ± 3% and 40% ± 5% for moderate mismatch, and 73% ± 5% and 46% ± 9% for no mismatch. For patients greater than 70 years, prosthesis–patient mismatch did not affect long-term survival (P = .25). Survival at 5 and 10 years was 62% ± 5% and 42% ± 6% for severe mismatch, 62% ± 2% and 30% ± 5% for moderate mismatch, and 53% ± 4% and 29% ± 5% for absent mismatch.

Conclusions: After bioprosthetic aortic valve replacement, prosthesis–patient mismatch had a negative impact on late survival for patients less than or equal to 70 years of age, but for patients greater than 70 years of age, prosthesis–patient mismatch did not influence late survival.

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COUNTERPOINT: Aortic valve replacement: Size does matter

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