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Marc R. Moon
Michael K. Pasque
Nabil A. Munfakh
Spencer J. Melby
Jennifer S. Lawton
Nader Moazami
John E. Codd
Traves D. Crabtree
Hendrick B. Barner
Ralph J. Damiano, Jr
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Right arrow Valve disease

Ann Thorac Surg 2006;81:481-489
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Prosthesis-Patient Mismatch After Aortic Valve Replacement: Impact of Age and Body Size on Late Survival

Marc R. Moon, MD * , Michael K. Pasque, MD, Nabil A. Munfakh, MD, Spencer J. Melby, MD, Jennifer S. Lawton, MD, Nader Moazami, MD, John E. Codd, MD, Traves D. Crabtree, MD, Hendrick B. Barner, MD, Ralph J. Damiano, Jr, MD

Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri

Accepted for publication July 26, 2005.

* Address correspondence to Dr Moon, Division of Cardiothoracic Surgery, Washington University School of Medicine, 3108 Queeny Tower, 1 Barnes-Jewish Plaza, St. Louis, MO 63110-1013 (Email: moonm{at}msnotes.wustl.edu).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: The purpose of this study was to identify patient subgroups in which prosthesis-patient mismatch most influenced late survival.

METHODS: Over a 12-year period, 1,400 consecutive patients underwent bioprosthetic (933 patients) or mechanical (467) aortic valve replacement. Prosthesis-patient mismatch was defined as prosthetic effective orifice area/body surface area less than 0.75 cm2/m2 and was present with 11% mechanical and 51% bioprosthetic valves.

RESULTS: With bioprosthetic valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 68% ± 7% mismatch versus 75% ± 7% no mismatch, p< 0.02) but not older patients (p= 0.47). Similarly, with mechanical valves, prosthesis-patient mismatch was associated with impaired survival for patients less than 60 years old (10-year: 62% ± 11% versus 79% ± 4%, p < 0.005) but not older patients (p = 0.26). For small patients (body surface area less than 1.7 m2), prosthesis-patient mismatch did not impact survival with bioprosthetic (p = 0.32) or mechanical (p= 0.71) valves. For average-size patients (body surface area 1.7 to 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with both bioprosthetic (p < 0.05) and mechanical (p< 0.005) valves. For large patients (body surface area greater than 2.1 m2), prosthesis-patient mismatch was associated with impaired survival with mechanical (p< 0.04) but not bioprosthetic (p= 0.40) valves.

CONCLUSIONS: Prosthesis-patient mismatch had a negative impact on survival for young patients, but its impact on older patients was minimal. In addition, although prosthesis-patient mismatch was not important in small patients, prosthesis-patient mismatch negatively impacted survival for average-size patients and for large patients with mechanical valves.




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