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Related Experiment Videos

[Avoidance of patient-prosthesis mismatch].

Y Sakamoto1, K Hashimoto

  • 1Department of Cardiovascular Surgery, the Jikei University School of Medicine, Tokyo, Japan.

Kyobu Geka. the Japanese Journal of Thoracic Surgery
|April 15, 2006
PubMed
Summary
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To minimize patient-prosthesis mismatch (PPM), aortic root enlargement is effective, especially for older patients receiving bioprosthetic valves. This strategy significantly reduces PPM incidence in diverse patient groups undergoing aortic valve replacement.

Area of Science:

  • Cardiac Surgery
  • Biomaterials Science
  • Prosthetic Valve Design

Context:

  • Patient-prosthesis mismatch (PPM) is a significant concern in aortic valve replacement (AVR), particularly in patients with small aortic annuli.
  • Minimizing PPM is crucial for optimizing long-term outcomes and hemodynamic performance after AVR.
  • Aortic root enlargement is a surgical technique employed to address small aortic annuli and prevent PPM.

Purpose:

  • To review the effectiveness of aortic root enlargement in preventing PPM.
  • To evaluate the incidence of PPM with different valve types (Carpentier-Edwards Perimount and St. Jude Medical) and surgical approaches.
  • To assess the suitability of bioprosthetic valves in older populations for avoiding PPM.

Summary:

  • Aortic root enlargement was routinely used to prevent PPM in patients with small aortic annuli.

Related Experiment Videos

  • Carpentier-Edwards Perimount (CEP) valves were used in 53 older patients, and St. Jude Medical (SJM) mechanical valves in 128 younger patients.
  • Aortic root enlargement was performed in 26 patients with small annuli and 24 younger patients. Only 2 (3.8%) CEP recipients and no SJM recipients developed PPM, resulting in an overall PPM prevalence of 1.1%.

    • Impact:

    • The study demonstrates a low incidence of PPM (1.1%) using aortic root enlargement, highlighting its efficacy.
    • Pericardial bioprosthetic valves are recommended for older patients to avoid PPM.
    • Aortic annular enlargement is the primary strategy for younger patients with small annuli, with high-performance mechanical valves as an alternative to avoid PPM.