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Published on: May 21, 2017
Prosthesis-patient mismatch in aortic stenosis
Kentaro Honda1, Yoshitaka Okamura
1Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan, honda-k@wakayama-med.ac.jp.
Background:
The clinical impacts of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) have been debated since Rahimtoola first reported PPM in 1978. Many reports discussing several aspects of PPM have been published to date, but the definitive clinical impacts of PPM have not yet been clarified.
Purpose:
The purpose of this review is to evaluate recent articles regarding PPM and discuss the latest findings.
Results:
Moderate PPM (indexed effective orifice area ≤ 0.85 cm(2)/m(2)) did not affect the surgical outcomes in several papers, but severe PPM (indexed effective orifice area ≤ 0.65 cm(2)/m(2)) affected early and late mortality in almost of the all papers in which it was reported. PPM had a greater effect on younger patients and patients with left ventricular dysfunction than it did on elderly patients and patients with preserved left ventricular function.
Conclusion:
Based on recent findings, it is difficult to define the impact of PPM after AVR. To some degree, PPM affects the clinical outcomes after AVR; therefore, it is important to avoid PPM, especially severe PPM.
Insights
Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) can impact mortality, especially severe PPM. Avoiding severe PPM is crucial for better clinical outcomes in AVR patients.
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.
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