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

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Prosthetic Valve Dynamics

Background:

• Prosthesis-patient mismatch (PPM) occurs when prosthetic valve size is inadequate for patient body size.
• This mismatch results in higher transvalvular gradients despite normal valve function.

Purpose of the Study:

• To review current knowledge on the clinical outcome implications of PPM.
• To highlight the prevalence and consequences of PPM in aortic valve replacement.

Main Methods:

• Literature review of studies investigating PPM and clinical outcomes.
• Analysis of haemodynamic data and patient survival rates post-aortic valve replacement.

Main Results:

• PPM is prevalent in 20-70% of aortic valve replacements.
• PPM is associated with impaired haemodynamic function, reduced left ventricular hypertrophy regression, increased cardiac events, and lower survival rates.
• PPM can be largely prevented through prospective surgical strategies.

Conclusions:

• Prosthesis-patient mismatch significantly impacts clinical outcomes after aortic valve replacement.
• Early identification and prevention of PPM are crucial for improving patient survival and cardiac health.