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

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 haemodynamic consequence is to generate higher than expected gradients through normally functioning prosthetic valves. This review updates the present knowledge about the impact of PPM on clinical outcomes. PPM is common (20–70% of aortic valve replacements) and has been shown to be associated with worse haemodynamic function, 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.

  • AVR, aortic valve replacement
  • BSA, body surface area
  • CFR, coronary flow reserve
  • EOA, effective orifice area
  • IGA, internal geometric area
  • LV, left ventricular
  • PPM, prosthesis-patient mismatch
  • TPG, transvalvar pressure gradient
  • heart valve disease
  • heart valve prosthesis
  • haemodynamic function
  • Doppler echocardiography
  • aortic stenosis

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  • Editorial
    BMJ Publishing Group Ltd and British Cardiovascular Society