Thorac cardiovasc Surg
DOI: 10.1055/s-0038-1676814
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Limitations in the Assessment of Prosthesis-Patient Mismatch

Paulo A. Amorim
1  Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
,
Mahmoud Diab
1  Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
,
Mario Walther
2  Department of Basic Sciences, University of Applied Sciences Jena, Jena, Germany
,
Gloria Färber
1  Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
,
Andreas Hagendorff
3  Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany
,
Robert O. Bonow
4  Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine Chicago, Chicago, Germany
,
Torsten Doenst
1  Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
› Author Affiliations
Further Information

Publication History

02 July 2018

14 November 2018

Publication Date:
04 January 2019 (online)

Abstract

Background Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) may affect survival but data are conflicting. It is assessed by relating effective orifice area (EOA) to body surface area (EOAi). EOA is patient-specific as the result of flow-velocity times area at the individual patient's outflow tract levels (LVOTA) divided by trans-prosthetic flow velocity. However, some studies use projected EOAs (i.e., valve size associated EOAs from other patient populations) to assess how PPM affects outcome.

Methods We analyzed 76 studies addressing hemodynamic outcome and/or mortality after bioprosthetic AVR.

Results In 48 studies, projected or measured EOA for calculation of EOAi and PPM assessment was used (of which 25 demonstrated an effect on survival). We identified 28 additional studies providing measured EOA values and the corresponding Bernoulli's pressure gradients after AVR. Despite EOA being a patient-specific parameter, 77% of studies assessing a PPM impact on survival used projected EOAs. The 28 studies are providing measured EOA values and the corresponding Bernoulli's pressure gradients in patients after AVR showed a highly significant, linear relationship between EOA and Bernoulli's gradient. Considering this relationship, it is surprising that relating EOA to body surface area (BSA) (EOAi) is standard but relating pressure gradients to BSA is not.

Conclusion We conclude that the majority of studies assessing PPM have used false assumptions because EOA is a patient-specific parameter and cannot be transferred to other patients. In addition, the use of EOAi to assess PPM may not be appropriate and could explain the inconsistent relation between PPM and survival in previous studies.

Sources of Funding

None disclosed.


Note

The papers were cited to exemplify relevant issues on publications addressing PPM as outlined in the manuscript. It is not our intention to criticize any particular publication.


Supplementary Material