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Prosthesis-Patient Mismatch After Aortic Valve Replacement.

Abdellaziz Dahou1, Haïfa Mahjoub1, Philippe Pibarot2

  • 1Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V-4G5, Canada.

Current Treatment Options in Cardiovascular Medicine
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Summary

Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) is linked to higher risks. Early diagnosis and prevention strategies, including transcatheter AVR, are crucial for better patient outcomes.

Keywords:
Aortic valve replacementDoppler echocardiographyProsthesis-patient mismatchProsthetic heart valvesTranscatheter aortic valve replacement

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Biomedical Engineering

Background:

  • Prosthesis-patient mismatch (PPM) is a common complication after aortic valve replacement (AVR).
  • PPM occurs when the prosthetic valve's effective orifice area (EOA) is disproportionately small for the patient's body size, leading to elevated postoperative gradients.
  • Severe PPM is associated with increased risks of morbidity and mortality.

Purpose of the Study:

  • To review the current understanding of PPM diagnosis, clinical impact, and prevention strategies following AVR.
  • To highlight the importance of identifying and mitigating PPM to improve patient outcomes.
  • To discuss the potential advantages of transcatheter AVR in preventing PPM.

Main Methods:

  • Differential diagnosis involves comparing measured EOA, assessing changes in valve area and gradients over time, and evaluating leaflet morphology and mobility.
  • Risk stratification for severe PPM and identification of patient vulnerability factors are key.
  • Comparison of outcomes between surgical AVR and transcatheter AVR regarding PPM prevention.

Main Results:

  • PPM is frequently observed after AVR and its severity correlates with adverse outcomes.
  • Accurate diagnosis differentiates PPM from prosthetic valve stenosis.
  • Transcatheter AVR may offer superior PPM prevention, especially in patients with small aortic annuli (<21 mm).

Conclusions:

  • Implementing preventive strategies for PPM is essential, particularly in high-risk patients.
  • Timely diagnosis and management of PPM can mitigate associated risks.
  • Transcatheter AVR shows promise in reducing PPM and related adverse cardiac events.