Live longer and better without prosthesis-patient mismatch

Abstract

In this issue of The Journal of Heart Valve Disease, Urso and co-workers (1) analyzed the impact of prosthesispatient mismatch (PPM) on survival and quality of life following aortic valve replacement (AVR) in 163 patients aged 75 years or more. Elderly patients currently represent a large proportion of the population undergoing AVR, and this proportion is expected to grow exponentially in the near future as the population ages. In this context, it becomes appropriate to determine the exact impact of PPM in this specific population in order to adopt the most appropriate strategies with regards to this age group. Indeed, these patients have often outlived their normal life expectancy, and their main motivation for consenting to surgery may be the expectation of an improved and/or maintained quality of life, rather than a prolonged survival. In this respect, the study by Urso et al. (1) is most interesting as these authors have analyzed the impact of PPM not only on the patients’ survival but also on their quality of life. Importantly, they found that, whereas moderate PPM had no impact on mid-term mortality in this cohort of elderly patients, it was nonetheless associated with a significant reduction in the quality of life.