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Prosthesis-Patient Mismatch After Aortic Valve Replacement

  • Valvular Heart Disease (J Passeri, Section Editor)
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Opinion statement

Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of a normally functioning prosthesis is too small in relation to the patient’s body size, resulting in abnormally high postoperative gradients. PPM is frequent following aortic valve replacement (AVR), and it is associated with increased risk of morbidity and mortality proportionally to its severity. Differential diagnosis between PPM and prosthetic valve stenosis is made by comparing the measured valve effective orifice area, by assessing the changes in valve area and gradient during follow-up and by evaluating leaflet morphology and mobility. Preventive strategies to avoid or minimize PPM should be implemented especially in the patients who are at high risk for severe PPM and in those who have vulnerability factors to PPM. Transcatheter AVR may be superior to surgical AVR for the prevention of PPM and associated adverse cardiac events, particularly in the subset of patients with a small (<21 mm) aortic annulus. In this article, we discuss the most updated data regarding the diagnosis, clinical impact, and prevention of PPM after AVR.

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  1. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, 2725 Chemin Sainte-Foy, Québec, Québec, G1V-4G5, Canada

    Abdellaziz Dahou MD, MSc, Haïfa Mahjoub MD, PhD & Philippe Pibarot DVM, PhD

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  1. Abdellaziz Dahou MD, MSc
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  2. Haïfa Mahjoub MD, PhD
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  3. Philippe Pibarot DVM, PhD
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Correspondence to Philippe Pibarot DVM, PhD.

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Abdellaziz Dahou and Haïfa Mahjoub each declare no potential conflicts of interest.

Philippe Pibarot reports grants from Edwards Lifesciences, Cardiac Phoenix, and V-Wave Ltd.

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Dahou, A., Mahjoub, H. & Pibarot, P. Prosthesis-Patient Mismatch After Aortic Valve Replacement. Curr Treat Options Cardio Med 18, 67 (2016). https://doi.org/10.1007/s11936-016-0488-0

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