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Abstract

Background

The clinical impact of patient prosthesis mismatch (PPM) following aortic valve replacement (AVR) has been debated. Furthermore, the impact of PPM on quality of life (QOL) is not well established. The aim of this study was to investigate the impact of PPM on outcome and QOL.

Methods

Demographic and operative data for patients undergoing AVR ± coronary artery bypass graft surgery (CABG) over a 2-year period was prospectively collected. Data on complications and outcomes were recorded during the hospital stay, at 3, 6 and 12 months. QOL assessment was performed using SF-36Ò questionnaires preoperatively and 6 and 12 months following discharge. PPM was diagnosed from the first postoperative echocardiogram. Patients who were in extremis and unable to participate were excluded.

Results

Over a two-year period, 173 consecutive patients underwent isolated AVR or AVR + CABG. Median age was 75 years and 64.2% were male. Twenty-six (15%) had PPM of which 11 (42.3%) had severe PPM and the remainder had moderate PPM. The incidence of stroke was 7.7% and 5.4% in those with and without PPM respectively, p=0.81. In hospital mortality was 7.7% and 6.2% in those with and without PPM, p=0.44. There was a significant reduction in LV mass following surgery, except in those with severe PPM, p=0.07. At one year, there was no difference in mortality between those with and without PPM, p=0.2. No patients required reintervention for PPM. In those with severe PPM, there was a significant reduction in QOL mental component scores (p=0.01) and no improvement in QOL physical component score in those with severe PPM, p=0.38.

Conclusions

In patients undergoing AVR, PPM does not impact early postoperative outcomes, regardless of the degree of PPM. There is no significant impact on mortality or reintervention up to one year follow up. In those with severe PPM, QOL scores were lower during follow up.

Publication Type:	Thesis (Doctoral)
Subjects:	Q Science > Q Science (General) R Medicine > R Medicine (General)
Departments:	School of Health & Medical Sciences > Cardiovascular and Genomics Research Institute School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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