Hemodynamic and clinical impact of prosthesis–patient mismatch in the aortic valve position and its prevention

• Published in: Journal of the American College of Cardiology Vol. 36; no. 4; pp. 1131 - 1141
• Main Authors: Pibarot, Philippe, Dumesnil, Jean G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2000; Elsevier Science
• Subjects: Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Biological and medical sciences; Echocardiography, Doppler, Color; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Hemodynamics - physiology; Humans; Medical sciences; Prosthesis Failure; Prosthesis Fitting; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; BSA; EOA; LV; Human; Prognosis; Pathophysiology; Prosthesis; Mortality; Cardiovascular disease; Exploration; Mismatching; Morbidity; Functional capacity; Prevention; Treatment; Heart disease; Surgery; Risk factor; Complication; Hemodynamics; Aortic valve
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(00)00859-7

Prosthesis–patient mismatch is present when the effective orifice area of the inserted prosthetic valve is less than that of a normal human valve. This is a frequent problem in patients undergoing aortic valve replacement, and its main hemodynamic consequence is the generation of high transvalvular gradients through normally functioning prosthetic valves. The purposes of this report are to present an update on the concept of aortic prosthesis–patient mismatch and to review the present knowledge with regard to its impact on hemodynamic status, functional capacity, morbidity and mortality. Also, we propose a simple approach for the prevention and clinical management of this phenomenon because it can be largely avoided if certain simple factors are taken into consideration before the operation.