Key result
Patient-prosthesis mismatch complicates ~50% of SAVR cases and worsens outcomes, particularly with reduced LVEF.
Why the study?
The clinical impact of aortic patient-prosthesis mismatch, particularly after transcatheter aortic valve replacement, and optimal strategies to address it remain matters of ongoing debate.
What is the impact of patient-prosthesis mismatch after aortic valve replacement, and how can it be diagnosed and prevented?
What is the impact of patient-prosthesis mismatch after aortic valve replacement, and how can it be diagnosed and prevented?
Patient-prosthesis mismatch is common after SAVR and impacts outcomes particularly in patients with reduced LVEF, whereas its prevalence in TAVR is much lower.
May warrant vigilance for PPM in reduced-LVEF SAVR patients; leaves open TAVR outcome benefits.
Patient-prosthesis mismatch (PPM) is the situation in which the area of an artificial valve is smaller than that of a healthy native valve it replaces. By this definition, all artificial valves demonstrate PPM, but large observational studies and several meta-analyses suggest that it is present in 30-50% of patients after surgical aortic valve replacement (SAVR). PPM has an impact on outcomes only when the indexed aortic valve area (AVAi) is ≤0.85cm2/m2 (moderate PPM) or 0.65cm2/m2 (severe PPM), particularly in patients with reduced LVEF. In transcatheter aortic valve replacement, the prevalence of PPM may be as low as 0.1%, and its impact on hard outcomes is not clear. We present a review of the relevant literature together with a framework for the differential diagnosis of increased pressure gradient and reduced area in prosthetic aortic valves and different strategies to reduce the risk of PPM with SAVR.
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Visan et al. (2024) conducted a review in Patient-prosthesis mismatch after aortic valve replacement. Aortic valve replacement was evaluated. Patient-prosthesis mismatch occurs in 30-50% of patients after surgical aortic valve replacement and impacts outcomes when indexed aortic valve area is ≤0.85cm2/m2, especially with reduced LVEF.
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