Prosthesis-Patient Mismatch Following Aortic Valve Replacement-A Comprehensive Review

Area of Science:

• Cardiology
• Cardiac Surgery
• Biomedical Engineering

Background:

• Prosthesis-patient mismatch (PPM) is a critical complication following aortic valve replacement (AVR).
• PPM occurs when the implanted valve's effective orifice area is disproportionately small for the patient's body size.
• This mismatch significantly impacts hemodynamics, cardiac remodeling, and long-term survival.

Purpose of the Study:

• To comprehensively review the pathophysiology, clinical consequences, and therapeutic strategies for PPM in both surgical AVR (SAVR) and transcatheter AVR (TAVR).
• To synthesize current evidence on PPM prevalence, hemodynamic effects, patient outcomes, and methods for mitigation.

Main Methods:

• A narrative review was performed, systematically searching PubMed and Embase databases.
• Keywords included "aortic valve replacement" and "prosthesis-patient mismatch."
• Key studies and reviews were screened, focusing on PPM prevalence, hemodynamic impact, clinical outcomes, and mitigation strategies.

Main Results:

• PPM prevalence varies (5-30% SAVR, 2-35% TAVR), defined by indexed effective orifice area (iEOA) thresholds.
• PPM is linked to increased gradients, impaired LV mass regression, coronary flow issues, heart failure, and mortality.
• Newer TAVR and surgical valves show lower PPM rates; valve-in-valve and bioprosthetic valve fracture offer some benefit but have limitations.

Conclusions:

• PPM is a common, consequential complication of AVR, compromising long-term outcomes.
• Prevention through accurate preoperative assessment, valve sizing, and potential annular enlargement is key.
• Optimizing valve selection and preventing PPM during the initial procedure are vital for survival and future treatment options.