Valve Prosthesis–Patient Mismatch (VP–PM)

Abstract

The concept/phenomenon of valve prosthesis/patient mismatch (VP-PM), described in 1978, has stood the test of time. From that time to 2011, VP-PM has received a great deal of attention but studies have come to varying conclusions. This is largely because of the determination of prosthetic heart valve area [called effective orifice area index (EOAi)] by projection rather than by actual measurement, variable criteria to assess severity of EOAi and the timing of determination of EOAi. All prosthetic heart valves have some degree of VP-PM which must be placed in a proper clinical perspective. This can be done by determining its effects on function and outcomes. For mortality one needs to focus especially on severe/critical degree of VP-PM and determine the cause of death was due to VP-PM. For the period "beyond 2011" a road map is suggested that will have uniformity of assessment of VP-PM and a focusing on the important goals of VP-PM.

On the Mechanics of Transcatheter Aortic Valve Replacement

“…Rahimtoola et al 19, 100 defined prosthesis-patient mismatch as an effective orifice area (EOA) smaller than that of a normal human valve. Successively Dumesnil and Pibarot explained that this definition can be applied to almost all valve replacements 28 .…”

Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis

“…[14][15][16] After aortic valve replacement, residual LV afterload often is estimated by assessing the transvalvular pressure gradient, effective orifice area, and degree of valve prosthesis-patient mismatch. 17,18 However, focusing on valve hemodynamics alone may be inadequate as evidenced by a recent study showing increased vascular stiffness after transcatheter aortic valve replacement (TAVR). 19 Total vascular hydraulic load includes steady and pulsatile components.…”

The Narrow Aortic Root. A Continuing Surgical Challenge

“…The concept of prosthesis-patient mismatch relates the size of the prosthesis implanted, with the size of the patient. 2,3 In my experience, in the vast majority of cases a 21mm bioprostheses, largely predominant in the current study, is very rarely associated to mismatch, but the same probably cannot be said for a size 19. Again, this depends of the patient's somatic type, and I acknowledge the fact that the Dutch patients treated by Wollersheim and colleagues are mostly tall and heavy.…”