Prosthesis-patient mismatch: definition, clinical impact, and prevention

TLDR

Prosthesis‑patient mismatch occurs when the effective orifice area of a prosthetic valve is too small relative to body size, producing higher than expected gradients through normally functioning valves. The review aims to update knowledge on how prosthesis‑patient mismatch affects clinical outcomes. The authors conduct a systematic review of existing studies on prosthesis‑patient mismatch. PPM occurs in 20–70 % of aortic valve replacements and is linked to poorer haemodynamics, less regression of left ventricular hypertrophy, increased cardiac events, reduced survival, and can largely be prevented by a prospective operative strategy.

Abstract

Prosthesis-patient mismatch (PPM) is present when the effective orifice area of the inserted prosthetic valve is too small in relation to body size. Its main haemodynamic consequence is to generate higher than expected gradients through normally functioning prosthetic valves. This review updates the present knowledge about the impact of PPM on clinical outcomes. PPM is common (20–70% of aortic valve replacements) and has been shown to be associated with worse haemodynamic function, less regression of left ventricular hypertrophy, more cardiac events, and lower survival. Moreover, as opposed to most other risk factors, PPM can largely be prevented by using a prospective strategy at the time of operation.