Impact of prosthesis-patient size on functional recovery after aortic valve replacement

• Published in: Circulation (New York, N.Y.) Vol. 111; no. 24; pp. 3221 - 3229
• Main Authors: KOCH, Colleen Gorman, KHANDWALA, Farah, ESTAFANOUS, Fawzy G, LOOP, Floyd D, BLACKSTONE, Eugene H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 21-06-2005
• Subjects: Adult; Animals; Aortic Valve - surgery; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - surgery; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Data Collection; Diseases of the aorta; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Follow-Up Studies; Heart Valve Prosthesis - standards; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Orthopedic surgery; Prosthesis Design; Quality of Life; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Human; Functional recovery; Prosthesis; valves; Cardiovascular disease; quality of life; Aortic valve; stenosis; surgery
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circulationaha.104.505248

Prosthesis-patient size mismatch results when an implanted prosthetic aortic valve is of insufficient size for a patient's body surface area. The relation between prosthesis-patient size and functional capacity and adverse postoperative outcome is inconsistent. Our objectives were to examine the impact of valve replacement, continuous prosthesis-patient size, and other factors on functional recovery after aortic valve replacement (AVR) with the Duke Activity Status Index (DASI).
From June 15, 1995, through May 14, 1998, 1108 patients underwent AVR after completing a DASI survey. Of these, 1014 completed a postoperative DASI survey at an average of 8.3 months postoperatively. Logistic ordinal regression was used to examine the influence of demographic variables, comorbidities, baseline DASI scores, indexed valve orifice area, standardized orifice size, and postoperative morbid events on postoperative DASI. There was overall improvement in postoperative functional recovery reflected by median preoperative and postoperative DASI scores of 29 and 46, P<0.001, respectively. Neither indexed orifice area, P=0.94, nor standardized orifice size, P=0.96, was associated with functional recovery. Female sex, increasing age, elevated serum creatinine, increased central venous pressure, and red blood cell transfusion were factors associated with poor postoperative functional recovery.
A majority of patients report improvement in functional quality of life early after AVR. Similar functional recovery was demonstrated for patients along the full spectrum of valve sizes indexed to body size, even for values considered to represent severe mismatch for patient size. Factors other than prosthesis-patient size influence functional quality of life early after AVR.