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Correspondence

Prosthesis-Patient Mismatch in the Elderly

Department of Cardiac Surgery, University Hospital Rebro Zagreb, Kispaticeva 12, Zagreb, 10 000 Croatia

(Email: hgasparovic{at}kbc-zagreb.hr).

To the Editor:

I read with great interest the article by Vicchio and colleagues [1] on the very important and still controversial issue of patient prosthesis mismatch in an elderly population. My concern is that the reluctance to implant tissue valves in this patient cohort is unjustified. The valve-related morbidity of a mechanical prosthesis in this population of patients is expected to far surpass its marginal hemodynamic gain [2]. The authors emphasize the greater durability of mechanical prosthesis compared with tissue valves. Although this is certainly true, it bears no clinical relevance in this elderly population of patients [3].

The life expectancy of the presented cohort was further compromised by coronary artery disease that required surgical revascularization in more than a fifth of patients. With the risk of elective reoperations steadily decreasing and the prospect of transcatheter valve-in-valve prosthesis implantations on the horizon, I would have no hesitation in implanting tissue valves in the presented elderly population [4].

	References

Top References

 

1. Vicchio M, Della Corte A, De Santo LS, et al. Prosthesis-patient mismatch in the elderly: survival, ventricular mass regression, and quality of life Ann Thorac Surg 2008;86:1791-1797.[Abstract/Free Full Text]
2. El Oakley R, Kleine P, Bach DS. Choice of prosthetic heart valve in today's practice15 Circulation 2008;117:253-256.[Free Full Text]
3. Chan V, Jamieson WR, Germann E, et al. Performance of bioprostheses and mechanical prostheses assessed by composites of valve-related complications to 15 years after aortic valve replacement J Thorac Cardiovasc Surg 2006;131:1267-1273.[Abstract/Free Full Text]
4. Svensson LG, Dewey T, Kapadia S, et al. United States feasibility study of transcatheter insertion of a stented aortic valve by the left ventricular apex Ann Thorac Surg 2008;86:46-54.[Abstract/Free Full Text]

This article has been cited by other articles:

				M. Vicchio, A. Della Corte, M. De Feo, and M. Cotrufo Reply. Ann. Thorac. Surg., August 1, 2009; 88(2): 710 - 710. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hrvoje Gasparovic Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gasparovic, H. Search for Related Content PubMed PubMed Citation Articles by Gasparovic, H. Related Collections Valve disease Related Article