Prosthesis-patient mismatch: definition, clinical impact, and prevention

Philippe Pibarot ^1* and Jean G Dumesnil ¹

¹ Laval Hospital Research Center, Laval University, Quebec, Canada

^* To whom correspondence should be addressed. E-mail: philippe.pibarot{at}med.ulaval.ca.

Accepted 2 October 2005

Abstract

Prosthesis-patient mismatch (PPM) is present when the effective orifice area of the inserted prosthetic valve is too small in relation to body size. Its main hemodynamic consequence is to generate higher than expected gradients through normally functioning prosthetic valves. The purpose of this review is to present an update on the present knowledge with regard to the impact of PPM on clinical outcomes. PPM is indeed a frequent occurrence (20-70% of aortic valve replacements) that has been shown to be associated with worse hemodynamics, less regression of left ventricular hypertrophy, more cardiac events, and lower survival. Moreover, as opposed to most other risk factors, PPM can largely be prevented by using a prospective strategy at the time of operation.

Keywords: aortic stenosis, Doppler-echocardiography, heart valve disease, heart valve prosthesis, hemodynamics

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