T1 - Prosthesis-Patient Mismatch. Another Reason for TAVR?*

For PHVs of the same size, there was a wide range of EOAs. Two echocardiographic/Doppler studies from the Mayo Clinic of patients studied within 1 week of mitral porcine mitral bioprosthesis and of tricuspid mechanical prostheses showed a wide range of gradients and EOAs with the same size of PHV, even in the same brand of PHV.

KW - Prosthesis-patient mismatch

T1 - Prosthesis-patient mismatch in bovine pericardial aortic valves

KW - Prosthesis-patient mismatch

4 phases of physiological healing of mechanical and bioprosthetic PHVs have been described; they are “platelet and fibrin deposition, inflammation, granulation tissue, and finally encapsulation. Long-term device fibrous encapsulation with extension to adjacent tissues adds to structural stability.” Bioprosthetic valves undergo morphological changes of both the tissue material as well as the supporting structures, which may contribute to VP–PM. Valve leaflets become covered by fibrin, platelets, and other cellular material. The matrix of the leaflets undergoes microcalcification as well insulation with plasma materials, causing changes in the matrix structure. These changes may change the resistive properties of leaflet materials. In both mechanical and bioprosthetic valves, a fibrous sheath may also encapsulate the supporting structure of the valve, encroaching on the PHV orifice and also possibly causing valve leaflet or disk immobilization.

Valve Prosthesis–Patient Mismatch (VP–PM): A Long …

N2 - Objective: We sought to examine the relationship between the degree of prosthesis-patient mismatch and long-term survival after mechanical aortic valve replacement. Methods: Prospectively collected long-term follow-up data from 469 consecutive patients who underwent aortic valve replacement between 1995 and 1998 were reviewed. The indexed effective orifice area was derived from the reference normal values of effective orifice area divided by the patient's body surface area. Outcome was stratified according to the severity of prosthesis-patient mismatch: moderate mismatch was defined as 0.65 to 0.85 cm2/m2 and severe mismatch as less than 0.65 cm2/m2. The Cox proportional-hazards model with propensity score adjustment was used to adjust for the observed differences in baseline characteristics between the mismatch groups. Results: The degree of prosthesis-patient mismatch was minimal in 57% of patients, moderate in 39%, and severe in 4%. Predictors of clinically significant mismatch included small aortic valve sizes (19 and 21 mm), obesity, age greater than 65 years, and class III or IV heart failure. During a median follow-up period of approximately 7.9 years, overall survival was 77% in patients with minimal mismatch, 63% in those with moderate mismatch, and only 47% in those with severe mismatch (P

The normal aortic valve area is 3 to 4 cm 2 , a value rarely matched by a prosthetic valve.
It must be noted that all prosthetic heart valves (PHVs) are smaller than normal and thus are inherently stenotic.

Pre-Existing Patient-Valve Mismatch ..

AB - Background-The prevalence of prosthesis-patient mismatch (PPM) and its impact on survival after aortic valve replacement have not been clearly defined. Historically, the presence of PPM was identified from postoperative echocardiograms or preoperative manufacturer-provided charts, resulting in wide discrepancies. The 2009 American Society of Echocardiography (ASE) guidelines proposed an algorithmic approach to calculate PPM. This study compared PPM prevalence and its impact on survival using 3 modalities: (1) the ASE guidelines-suggested algorithm (ASE PPM); (2) the manufacturer-provided charts (M PPM); and (3) the echocardiographically measured, body surface area-indexed, effective orifice area (EOAi PPM) measurement. Methods and Results-A total of 614 patients underwent aortic valve replacement with bovine pericardial valves from 2004 to 2009 and had normal preoperative systolic function. EOAi PPM was severe if EOAi was ≤0.60 cm2/m2, moderate if EOAi was 0.60 to 0.85 cm2/m2, and absent (none) if EOAi was ≥0.85 cm2/m2. ASE PPM was severe in 22 (3.6%), moderate in 6 (1%), and absent (none) in 586 (95.4%). ASE PPM was similar to manufacturer-provided PPM (P=1.00). ASE PPM differed significantly from EOAi PPM (P

David P. Taggart; Prosthesis patient mismatch in aortic valve replacement: possible but pertinent?

Aortic Valve Prosthesis–Patient Mismatch and Long …

Patients who subsequently underwent replacement of the prosthesis were censored on the date of the replacement procedure. We defined structural valve deterioration (SVD) as leaflet degradation that required reoperation. It excluded a diagnosis of prosthetic valve endocarditis. Follow-up was by structured telephone interviews, review of the hospital records, and review of medical and echocardiographic documentation. The mean follow-up period was 3.1±2.1 years, and the follow-up rate was 95.0%.

transcatheter aortic valve replacement, and prosthesis-patient mismatch are discussed separately

Prosthesis–patient mismatch was classified as ..

Prosthesis-patient mismatch (PPM) is associated with increased mid-term and long-term mortality rates after aortic valve replacement (AVR). This study aimed to evaluate the efficacy of the Carpentier-Edwards Perimount Magna and Magna Ease (CEPMs) aortic bioprostheses to reduce the incidence of PPM.