Stentless bioprostheses in small aortic roots: impact of patient-prosthesis mismatch on survival and quality of life.

Abstract

BACKGROUND AND AIM OF THE STUDY:

Although stentless bioprostheses offer hemodynamic advantages, prosthetic valves of smaller size may provide less reduction of left ventricular hypertrophy and, therefore, affect survival and quality of life.

METHODS:

A total of 303 patients (mean age 75 +/- 7 years) who underwent aortic valve replacement with the stentless Freestyle bioprostheses were followed up. The impact of projected indexed effective orifice area (IEOA) on survival and quality of life (QoL) was determined multivariately by Cox regression and logistic regression analysis.

RESULTS:

Independent predictors of survival time were diabetes mellitus (p < 0.001), atrial fibrillation (p = 0.004), male gender (p = 0.015), peripheral vascular disease (p = 0.039), and patient-prosthesis mismatch (PPM, defined as projected IEOA < 0.75 cm2/m2) in patients with aortic regurgitation (p = 0.017). A history of congestive heart failure (p = 0.016), small body mass index (p = 0.01), age > 75 years (p = 0.002) and small projected IEOA (p = 0.016) were identified as predictors of impaired QoL.

CONCLUSION:

PPM and small projected IEOA were identified as independent risk factors for impaired mid-term survival and QoL. As the occurrence of PPM was rare in total root replacements, and the implantation procedure did not increase the operative risk in the present patient population, the recommendation is made to consider this implantation technique if a small projected IEOA is expected.

• Authors: Jürgen Ennker, Ulrich Rosendahl, Alexander Albert, Ercan Dumlu, Ina Carolin Ennker, Ines Florath
• Journal: The Journal of heart valve disease (J Heart Valve Dis) Vol. 14 Issue 4 Pg. 523-30 (Jul 2005) ISSN: 0966-8519 [Print] England
• PMID: 16116880 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Activities of Daily Living
• Aged
• Aortic Valve (surgery)
• Atrial Fibrillation (complications)
• Bioprosthesis
• Diabetes Complications
• Fatigue (complications)
• Female
• Follow-Up Studies
• Heart Valve Diseases (mortality, psychology, surgery)
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (methods)
• Humans
• Logistic Models
• Male
• Pain Measurement
• Proportional Hazards Models
• Prosthesis Design
• Prosthesis Fitting
• Quality of Life
• Risk Factors
• Sex Factors
• Sleep
• Social Isolation