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Related Experiment Video

Updated: May 13, 2026

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
09:20

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

Left Ventricular Outflow Tract Diameter Variability and Prosthesis-Patient Mismatch: A Simulation Study.

J W Taco Boltje1, Bart J J Velders1, Joseph F Sabik2

  • 1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands.

Interdisciplinary Cardiovascular and Thoracic Surgery
|May 11, 2026
PubMed
Summary

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This summary is machine-generated.

Prosthesis-patient mismatch incidence is unstable due to measurement variability in the effective orifice area, particularly the left ventricular outflow tract diameter. Small changes significantly impact mismatch prevalence, questioning its current use.

Area of Science:

  • Cardiovascular Surgery
  • Medical Device Performance
  • Prosthetic Valve Evaluation

Background:

  • The PERIGON Trial evaluated the Avalus valve, revealing discrepancies between effective orifice area and prosthesis-patient mismatch.
  • Effective orifice area (EOA) calculation is sensitive to left ventricular outflow tract (LVOT) diameter measurements, exhibiting significant intra- and interobserver variability.

Purpose of the Study:

  • To investigate the impact of variability in left ventricular outflow tract (LVOT) diameter measurements on the calculated incidence of severe prosthesis-patient mismatch (PPM).
  • To assess the stability and clinical utility of PPM, as currently defined by indexed EOA, in aortic valve replacement.

Main Methods:

  • A simulation was conducted altering the LVOT diameter by -2 mm to +2 mm.
  • Severe PPM incidence was recalculated based on these simulated LVOT diameter variations.
Keywords:
aortic valve replacementechocardiographyleft ventricular outflow tract diametermeasurement variabilityprosthesis-patient mismatch

Related Experiment Videos

Last Updated: May 13, 2026

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
09:20

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

Main Results:

  • Altering LVOT diameter by ±1 mm significantly changed severe PPM prevalence, ranging from 13.3% to 0.3%.
  • A 1 mm variability in LVOT measurement can nearly double or halve the reported incidence of severe PPM.
  • The original simulation showed a 3.1% severe PPM incidence.

Conclusions:

  • Indexed EOA-based PPM is highly unstable and significantly influenced by minor, clinically realistic variations in LVOT diameter.
  • Current methods for assessing PPM lack robustness and should not be relied upon in isolation for clinical decision-making.
  • Further research is needed to refine PPM assessment and improve its reliability in evaluating prosthetic heart valve performance.