Prosthesis-Patient Mismatch and Aortic Root Enlargement: Indications, Techniques and Outcomes

Area of Science:

• Cardiac Surgery
• Cardiovascular Medicine
• Biomedical Engineering

Background:

• Prosthesis-patient mismatch (PPM) occurs when an aortic valve prosthesis is too small for the patient.
• PPM leads to elevated transvalvular gradients, left ventricular dysfunction, and increased morbidity and mortality.
• Younger patients and those with preoperative left ventricular dysfunction are particularly vulnerable.

Purpose of the Study:

• To review the definition, consequences, and prevention strategies for prosthesis-patient mismatch (PPM) in aortic valve replacement.
• To discuss surgical techniques for aortic root enlargement (ARE) to prevent PPM.

Main Methods:

• Review of existing literature on prosthesis-patient mismatch (PPM) and aortic root enlargement (ARE) techniques.
• Discussion of echocardiographic methods for effective orifice area (EOA) measurement.
• Analysis of established and contemporary ARE procedures.

Main Results:

• In vivo echocardiography is the most reliable method for determining predicted effective orifice area (EOA).
• Surgical aortic root enlargement (ARE) techniques, including Nicks, Manouguian, Konno-Rastan, and the Yang procedure, can effectively address PPM.
• The Yang procedure shows promise for safely increasing aortic root size by two to three sizes.

Conclusions:

• Aortic root enlargement (ARE) is a valuable and safe surgical strategy for preventing prosthesis-patient mismatch (PPM).
• ARE should be considered during the surgical planning for patients at risk of PPM.
• Effective prevention of PPM can improve long-term outcomes after aortic valve replacement.