Dejan Došen

Impact of mild patient prosthesis mismatch on quality of life in patients with preserved ejection fraction after isolated aortic valve replacement for aortic stenosis

AIM To analyze whether PPM affects QOL and functional status in patients after isolated AVR for aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). METHODS Consecutive patients who underwent AVR in University Hospital Center Zagreb for isolated severe symptomatic AS and preserved EF were enrolled. Echo data was obtained from complete transthoracic examinations prior and after surgery by offline analysis. Patients were divided into two groups according to the presence of PPM (effective orifice area (EOA)/body surface area (BSA)<0,85cm2/m2). QOL was assessed by telephone interview using Short Form 36-Item Health Survey (SF-36) along with functional NYHA status estimation. RESULTS A total of 45 pts were included (23 female), and divided in PPM (n=26), and non-PPM group (n=19). Both groups were similar in pts age, LVEF, AVA/BSA prior surgery. After surgery, 57% of pts had PPM categorized as mild PPM. During follow-up of 2,5years, 3 pts had died and 10 were lost from following. There was no difference in NYHA status after surgery between groups (p=0,758). SF36 results showed no difference between groups. However, there was a significant improvement in Physical functioning (47,50% vs 75,47%,p=0,000) and Role limitation due to physical health (41,41% vs 81,25%, p=0,007) scores in the whole study population after AVR. Males had significantly better Energy/fatigue (p=0,034), Social functioning (p=0,004) and Pain (p=0,017) scores. CONCLUSIONS Mild to moderate PPM showed no clinical relevance. All patients revealed improvement in QOL after AVR, while male sex was related to better functioning scores irrespectively of PPM.