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Is the threshold for postoperative prosthesis-patient mismatch the same for all prostheses?
Homare Okamura1, Atsushi Yamaguchi, Hideki Morita
1Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan. homareokamura@hotmail.co.jp
The effective orifice area index (EOAI) threshold for prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) may need re-evaluation for mechanical valves. Current PPM definitions did not impact survival or left ventricular mass index in this study.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Clinical Hemodynamics
Background:
- Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) is defined using the effective orifice area index (EOAI).
- The established threshold for PPM may not be universally applicable across different prosthetic valve types.
Purpose of the Study:
- To assess hemodynamics in patients receiving a mechanical valve during AVR.
- To re-evaluate the validity of the commonly accepted EOAI threshold for PPM in mechanical valves.
Main Methods:
- Echocardiographic assessment of transvalvular pressure gradient and EOAI in 329 patients who underwent AVR with a St. Jude Medical Regent mechanical valve.
- Analysis of the commonly accepted PPM threshold in relation to patient survival.
Main Results:
- Mechanical valves frequently resulted in a postoperative transvalvular pressure gradient >10 mmHg, irrespective of EOAI.
- The relationship between transvalvular pressure gradient and EOAI differed from bioprosthetic valves, with a gentler slope.
- The commonly defined PPM did not significantly affect long-term survival or left ventricular mass index regression.
Conclusions:
- The hemodynamic relationship between transvalvular pressure gradient and EOAI differs for mechanical prostheses compared to the reference standard.
- These findings suggest a need to reconsider the PPM cutoff value for mechanical aortic valves.
