[Patient-prosthesis mismatch: myth or reality?]

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Clinical Cardiology

Context:

• Patient-prosthesis mismatch (PPM) occurs when an implanted aortic valve's surface area is too small for the patient's body size.
• PPM affects 20-70% of patients post-aortic valve replacement, impacting recovery and long-term health.
• The severity of PPM's impact varies based on patient factors like age and left ventricular condition.

Purpose:

• To define patient-prosthesis mismatch (PPM) and its prevalence after aortic valve replacement.
• To outline the adverse clinical outcomes associated with PPM.
• To discuss preventative strategies for PPM during aortic valve replacement surgery.

Summary:

• PPM is a frequent complication of aortic valve replacement, defined by inadequate prosthesis size relative to body surface area.
• It is associated with diminished symptomatic improvement, reduced left ventricular hypertrophy regression, impaired coronary reserve, and poorer survival rates.
• Vulnerable patient groups include the young and those with compromised left ventricular function or severe hypertrophy.

Impact:

• PPM can be mitigated or prevented through surgical strategies, such as supra-annular prosthesis implantation.
• Optimizing prosthesis hemodynamics and considering supra-annular placement are key preventative measures.
• Proactive PPM management can enhance recovery, reduce adverse cardiac events, and improve long-term survival post-aortic valve replacement.