POINT: Prosthesis-patient mismatch does not affect survival for patients greater than 70 years of age undergoing bioprosthetic aortic valve replacement

Objective: The purpose of this investigation was to examine the impact of prosthesis-patient mismatch after bioprosthetic aortic valve replacement on long-term survival in patients greater than 70 years of age compared with those less than or equal to 70 years of age. Methods: Between 1992 and 2007, 1399 patients underwent bioprosthetic aortic valve replacement, including 881 (63%) patients older than 70 years of age. Prosthesis-patient mismatch was defined as severe (prosthetic effective orifice area/body surface area < 0.65 cm²/m²), moderate (0.65-0.85 cm²/m²), or absent (>0.85 cm²/m²). For patients less than or equal to 70 years of age, mismatch was severe in 62 (12%), moderate in 251 (48%), and absent in 205 (40%). For patients greater than 70 years of age, mismatch was severe in 109 (12%), moderate in 451 (51%), and absent in 321 (37%). There was no difference in the distribution of prosthesis-patient mismatch between age groups (P = .50). Results: For patients less than or equal to 70 years, prosthesis-patient mismatch was associated with impaired long-term survival (P = .02). Survival at 5 and 10 years was 61% ± 7% and 28% ± 12% for severe mismatch, 65% ± 3% and 40% ± 5% for moderate mismatch, and 73% ± 5% and 46% ± 9% for no mismatch. For patients greater than 70 years, prosthesis-patient mismatch did not affect long-term survival (P = .25). Survival at 5 and 10 years was 62% ± 5% and 42% ± 6% for severe mismatch, 62% ± 2% and 30% ± 5% for moderate mismatch, and 53% ± 4% and 29% ± 5% for absent mismatch. Conclusions: After bioprosthetic aortic valve replacement, prosthesis-patient mismatch had a negative impact on late survival for patients less than or equal to 70 years of age, but for patients greater than 70 years of age, prosthesis-patient mismatch did not influence late survival.