EDUCATION IN HEART
Prosthesis–patient mismatch: myth or reality?
Correspondence to:
Dr Jean-Luc Monin, Department of Cardiology, Henri Mondor Hospital, 51 avenue De Lattre de Tassigny, 94010 Créteil, France; jean-luc.monin@hmn.aphp.fr
| The first 150 words of the full text of this article appear below. |
Valve replacement for severe calcified aortic stenosis (AS) is currently the second most frequently performed cardiac operation. In these patients, the insertion of a small size prosthesis is an issue of concern, because the incomplete relief of left ventricular obstruction might have the same consequences as native AS—namely, high trans-aortic pressure gradients and increased left ventricular afterload leading to persistent left ventricular hypertrophy and persistent symptoms. Valve prosthesis–patient mismatch (PPM) has been described when the implanted prosthesis is too small according to the patient’s body size, resulting in high postoperative gradients.1 Pibarot and colleagues have underscored the negative impact of PPM on early postoperative survival, especially in case of preoperative left ventricular dysfunction.2 In addition, the same authors have proposed a strategy, based on the projected indexed effective orifice area (EOA) of the prosthesis, to eventually indicate more complex interventions (that is, aortic root enlargement) in case of anticipated mismatch.
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