Impact Of Prosthesis-Patient Mismatch On Quality Of Life In Elderly Patients After Aortic Valve Replacement

ObjectivesThe main purpose of this prospective study was to determine if there are differences in changes in QOL scores at long-term postoperatively in elderly patient after aortic valve replacement.An additional aim was to assess whether the prosthesis-patient mismatch impacts the improvement of quality of life in elderly people after aortic valve replacement.MethodsWe used a prospective cohort study design.100 Consecutive patients whose age were more than 70 undergoing isolated aortic valve or simultaneous aortic valve-coronary artery bypass graft(CABG)procedures at our hospital from August 10,1995,through August 19,1998,were identified for enrollment.Patient-prosthesis mismatch(PPM)was defined as the prosthetic aortic valve EOAI was 0.85 cm2/m2 or less.The clinical follow-up was done 4 weeks,6 months after the operation,and at annual intervals.Cumulative and comparative analyses of long-term outcome and gradient pressure of prosthesis valve were performed.The quality of life was evaluated with the Short Form 36-Item Health Survey(SF-36)questionnaire.ResultsMean age at implantation was 74.7±5.7 years(range,70-87 years).Mean follow-up was years(7.3±4.5years).The thirty days mortality is 6.3%in mismatch group,3.3%in no mismatch group.The freedom from death in interval follow-up year didn't show significant difference between two groups in 1st,third,and fifth follow-up year,but shows significant difference between mismatch and no mismatch group in seventh follow-up year.The echocardiographic data shows significant difference of mean gradient pressure between two groups in the 1st year and 5th year following up.The general health and energy/vitality all improved from preoperative levels at most points of follow-up,there was no significant improvement at the third, fifth,and seventh year follow-up for emotional role,social role,or general mental health.At the first year follow-up,there was some evidence of improvement for the latter 2 categories,with the greater significant improvement in social function,but there is not significant difference between the two groups.ConclusionsQuality of life improved after aortic vale replacement in elderly patients,but Improvements in quality of life appears to be not related PPM.The interpret of PPM impacting Clinic outcome remains a controversial issue.