Patient Prosthesis Mismatch in SAVR: How Avoidable is It in the ‘Real World’?

Abstract

We set out to assess whether the preoperative prediction of patient-prosthesis mismatch by an algorithm popularised by Pibarot et al. is accurate compared to PPMM defined as AVA <0.85 cm2/m2 (‘any PPMM’) or as AVA <0.65cm2/m2 (‘severe’ PPMM). We studied 37 patients (16 female), with mean age 72.3 +/− 8.4 years, who had unplanned SAVR during 2019. By echo, 17 (19.7%) patients had severe PPMM (mean AVA (SD) = 0.55 (0.04) cm2). For the 0.85cm2/m2 cut-off, 14/37 patients (37%) had PPMM (mean AVA (SD) 0.70 (0.15) cm2. By the Pibarot algorithm, 21 (56.7%) patients were predicted to have any PPMM and 10 (27%) severe PPMM. The preoperative algorithm for the avoidance of patient prosthetic mismatch does not accurately identify patients who have postoperative PPMM as defined by echocardiography. Further refinements of the algorithm seem necessary before it can be used widely in clinical practice.