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(Circulation. 2005;111:3221-3229.)
© 2005 American Heart Association, Inc.

Cardiovascular Surgery

Impact of Prosthesis–Patient Size on Functional Recovery After Aortic Valve Replacement

Colleen Gorman Koch, MD, MS; Farah Khandwala, MS; Fawzy G. Estafanous, MD; Floyd D. Loop, MD; Eugene H. Blackstone, MD

From the Departments of Cardiothoracic Anesthesia (C.G.K.) and Biostatistics (F.K.); the Division of Anesthesia (F.G.E.); and the Department of Thoracic and Cardiovascular Surgery (F.D.L., E.H.B.), The Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to Colleen Gorman Koch, MD, MS, Department of Cardiothoracic Anesthesia (G-3), Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail kochc{at}ccf.org

Received September 7, 2004; revision received January 26, 2005; accepted February 24, 2005.

Background— 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).

Methods and Results— 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.

Conclusions— 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.

Key Words: prosthesis • stenosis • surgery • valves • quality of life

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