Key result
Prosthesis-patient mismatch complicates ~70% of AVR cases and is linked to increased morbidity and mortality.
Prosthesis-patient mismatch is a frequent complication after aortic valve replacement that cardiac anesthesiologists must recognize and help prevent using echocardiography and appropriate surgical strategies.
Answers are grounded in this paper and cite their sources.
May warrant anesthesiologist vigilance for PPM post-AVR; leaves open optimal prevention strategies for prospective trials.
Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.
No takes yet. Share an insight, caveat, or question.
Subramaniam et al. (2017) conducted a review in Prosthesis-patient Mismatch (PPM). Prosthesis-patient mismatch occurs in up to 70% of patients after aortic valve replacement, with severe forms in up to 20%, leading to increased short- and long-term morbidity and mortality.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: