Hemodynamic and clinical impact of prosthesis–patient mismatch in the aortic valve position and its prevention

Pîbarot, Philippe; Dumesnil, Jean G.

doi:10.1016/s0735-1097(00)00859-7

Cited by 549 publications

(480 citation statements)

References 91 publications

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“…Calculations based on patients’ body surface area, direct measurements of the aortic root during surgery, and echocardiographic parameters such as transvalvular gradient and EOA are calculated to assess PPM. In general, an echocardiographically derived prosthetic EOA, indexed to body surface area (indexed EOA), of ≤0.60 cm 2 /m 2 is considered severe, of 0.60 to 0.85 cm 2 /m 2 is moderate, and ≥0.85 cm 2 /m 2 is considered nonsignificant 19, 20, 21. Based on the surgical literature, severe PPM following aortic valve replacement is associated with worse clinical outcomes, less reduction in left ventricular mass, and lower long‐term survival 22, 23.…”

Section: Prosthesis–patient Mismatchmentioning

confidence: 99%

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Shivaraju

Michel

Frangieh

et al. 2018

JAHA

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Section: Prosthesis–patient Mismatchmentioning

confidence: 99%

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Shivaraju

Michel

Frangieh

et al. 2018

JAHA

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“…When the aortic annulus of the patient is too small to allow a prosthetic valve with enough EOA in relation to the body surface area, the transvalvular gradient remains high, the prosthesis remains stenotic, and left ventricular hypertrophy does not regress, leading to negative outcomes. An EOAI less than 0.85 cm 2 /m 2 is generally regarded as the threshold for PPM, 8) however, it is still controversial as to whether moderate PPM infl uences long-term survival, especially for the elderly. 9-11) In ) in which Q denotes transvalvular fl ow or cardiac output, and k is a constant.…”

Section: Discussionmentioning

confidence: 99%

“…Although an indexed effective orifice area (EOAI) of a prosthetic aortic valve less than 0.85 cm 2 /m 2 is generally regarded as the threshold for PPM, 8) it is still controversial as to whether or not moderate PPM infl uences long-term survival, especially for the elderly. [9][10][11] In general, Asians have a smaller body surface area than Westerners.…”

mentioning

confidence: 99%

Moderate Prosthesis-Patient Mismatch May Be Negligible in Elderly Patients Undergoing Conventional Aortic Valve Replacement for Aortic Stenosis

et al. 2013

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SummaryTogether with aging of the Japanese population, aortic valve replacement (AVR) for aortic stenosis (AS) is now becoming more and more common in the elderly. When the aortic annulus is too small to allow an adequate sized prosthetic valve, aortic root enlargement is required to avoid prosthesis-patient mismatch (PPM). However, age-related comorbidities including aortic root calcifi cation bring signifi cant risk in performing aortic root enlargement. In the present study, 40 patients aged 75 years or more who underwent AVR for AS were reviewed to determine whether moderate PPM has a negative impact on the long-term results. Operative mortality occurred in 2 patients (5%) and moderate PPM occurred in 8 patients. There was no signifi cant difference in survival between cases with and without PPM (P = 0.87). Both aortic pressure gradient (PG) and left ventricular mass index (LVMI) measured by echocardiography were significantly decreased in patients with and without PPM. Reduction of PG was signifi cantly greater in patients with PPM than without PPM (P = 0.02). Reduction of LVMI was not different between the groups (P = 0.58). Moderate PPM did not negatively infl uence survival or reduction of PG or LVMI in patients aged 75 years or older who underwent AVR for AS. (Int Heart J 2013; 54: 11-14)

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“…Because most prosthetic valves are inherently stenotic, the effective orifice area of a prosthetic valve is occasionally too small in relation to body size, a phenomenon known as valve prosthesis-patient mismatch (PPM) (85,86). In the aortic position, PPM is considered moderate when the indexed effective orifice area is Յ0.85 cm 2 /m 2 and severe when it is Յ0.65 cm 2 /m 2 (87). In the mitral position, the cutoff values are 1.2 and 0.9 cm 2 /m 2 , respectively.…”

Section: Prosthetic Heart Valvesmentioning

confidence: 99%

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

Lancellotti¹,

Monin²,

Bonow³

2009

Stress Echocardiography

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Exercise testing has an established role in the evaluation of patients with valvular heart disease and can aid clinical decision making. Because symptoms may develop slowly and indolently in chronic valve diseases and are often not recognized by patients and their physicians, the symptomatic, blood pressure, and electrocardiographic responses to exercise can help identify patients who would benefit from early valve repair or replacement. In addition, stress echocardiography has emerged as an important component of stress testing in patients with valvular heart disease, with relevant established and potential applications. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. The versatile applications of stress echocardiography can be tailored to the individual patient with aortic or mitral valve disease, both before and after valve replacement or repair. Hence, exercise-induced changes in valve hemodynamics, ventricular function, and pulmonary artery pressure, together with exercise capacity and symptomatic responses to exercise, provide the clinician with diagnostic and prognostic information that can contribute to subsequent clinical decisions. Nevertheless, there is a lack of convincing evidence that the results of stress echocardiography lead to clinical decisions that result in better outcomes, and therefore large-scale prospective randomized studies focusing on patient outcomes are needed in the future. Advances in diagnosis and risk stratification, combined with steady progress in surgical valve replacement and repair, have led to improved outcomes of patients with valvular heart disease over the past 5 decades. The most important indication for surgical intervention in patients with hemodynamically significant aortic or mitral valve disease is the development of symptoms, as emphasized in recent guidelines (1,2). Because symptoms may develop slowly and indolently in these chronic conditions, many patients are unaware of subtle changes in effort tolerance, even when questioned directly by their physicians. Hence, guidelines of both the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) (1,2) have placed renewed emphasis on the role of exercise testing to provide objective evidence of exercise capacity and symptom status. In addition, although Doppler echocardiography at rest is the method of choice for assessing severity of valvular disease, there is a growing use of stress 2-dimensional and Doppler echocardiography to assess dynamic changes in hemodynamics in concert with the clinical findings of exercise testing.Stress echocardiography is well established for evaluating patients with coronary artery disease (CAD) (3-5). The role of stress echocardiography for the assessment of the hemodynamic consequences of valvular lesions was initially proposed in the 1980s (6,7) but only recently gained recognition by specialized and general guidelines (1,2,8,9). In a number...

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Hemodynamic and clinical impact of prosthesis–patient mismatch in the aortic valve position and its prevention

Cited by 549 publications

References 91 publications

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Moderate Prosthesis-Patient Mismatch May Be Negligible in Elderly Patients Undergoing Conventional Aortic Valve Replacement for Aortic Stenosis

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

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