Prosthesis-patient mismatch in aortic stenosis.

Area of Science:

• Cardiovascular Surgery
• Prosthetic Heart Valves
• Clinical Outcomes Research

Background:

• The clinical significance of prosthesis-patient mismatch (PPM) following aortic valve replacement (AVR) remains debated since its initial report in 1978.
• Despite numerous publications, the definitive clinical impacts of PPM after AVR have not been fully elucidated.

Purpose of the Study:

• To review recent literature on prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR).
• To discuss the latest findings and clarify the clinical impacts of PPM.

Main Methods:

• Systematic review of recent articles on prosthesis-patient mismatch (PPM).
• Analysis of studies reporting on the relationship between PPM severity and patient outcomes after AVR.

Main Results:

• Severe PPM (indexed effective orifice area ≤ 0.65 cm(2)/m(2)) was associated with increased early and late mortality in most reported cases.
• Moderate PPM (indexed effective orifice area ≤ 0.85 cm(2)/m(2)) did not consistently affect surgical outcomes.
• PPM had a more pronounced effect on younger patients and those with left ventricular dysfunction compared to elderly patients or those with preserved function.

Conclusions:

• The precise impact of PPM after AVR is challenging to definitively establish based on current evidence.
• PPM, particularly severe PPM, influences clinical outcomes following AVR.
• Strategies to avoid PPM, especially severe PPM, are recommended to improve patient results after AVR.