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Reconsideration of patient-prosthesis mismatch definition from the valve indexed effective orifice area

Yoshimasa Sakamoto1, Michio Yoshitake, Hirokuni Naganuma

  • 1Department of Cardiac Surgery, Jikei University School of Medicine, Tokyo, Japan. ysakamoto@jikei.ac.jp

The Annals of Thoracic Surgery
|May 25, 2010
PubMed
Abstract

Insights

The standard definition for patient-prosthesis mismatch (PPM) using indexed effective orifice area (iEOA) less than 0.85 cm(2)/m(2) may not accurately reflect hemodynamic performance. A reassessment suggests a threshold of iEOA less than 2.0 cm(2)/m(2) for optimal outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Biomedical Engineering
  • Prosthetic Valve Performance

Background:

  • Patient-prosthesis mismatch (PPM) is typically defined by an indexed effective orifice area (iEOA) < 0.85 cm(2)/m(2).
  • The clinical significance of this threshold in aortic valve replacement requires re-evaluation.

Purpose of the Study:

  • To reassess the validity of the current definition of PPM in the aortic position.
  • To determine an appropriate iEOA threshold for optimal hemodynamic performance with specific prosthetic valves.

Main Methods:

  • Analysis of 342 patients who underwent aortic valve replacement with Carpentier-Edwards Perimount valves.
  • Calculation of transvalvular pressure gradient and EOA using the modified Bernoulli and continuity equations.

Main Results:

  • Prevalence of PPM was 6.1% using the < 0.85 cm(2)/m(2) definition.
  • No significant survival difference was observed between patients with moderate PPM and those without.
  • Most patients exhibited a mean transvalvular pressure gradient > 10 mm Hg, irrespective of PPM status.

Conclusions:

  • The current iEOA < 0.85 cm(2)/m(2) threshold may be inadequate for defining PPM.
  • An iEOA < 2.0 cm(2)/m(2) may be a more appropriate threshold to achieve a low mean transvalvular pressure gradient (< 10 mm Hg).
  • Prosthesis-specific hemodynamic performance must be considered when defining PPM to avoid residual transvalvular pressure gradients.

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